Associations of physical activity with incident hip fracture outcomes depending on glycemic status: a nationwide population-based cohort study

초록

Physical activity (PA) is known to reduce fracture risk. However, it is not known wheth-er the effects of PA for reducing fracture risk may differ according to the glycemic status. We evaluated the effect of PA or exercise on incident hip fracture according to the glycemic sta-tus.We examined health examination data and claims records of 10,601,275 participants who underwent health examinations in 2009 from the Korean National Health Insurance Service. After excluding the subjects who were younger than 50 years, type 1 diabetes, or had a previ-ous history of fractures, a total of 3,723,097 subjects (1,861,865 men and 1,861,232) were fi-nally included in the analysis cohort. The level of leisure-time physical activity was assessed using metabolic equivalent task (MET)-min and categorized into 4 groups: <500, 500-999, 1000-1499, and >=1500 MET-min/week. Participants were classified into five groups ac-cording to their glycemic status: normal glucose tolerance (NGT), impaired fasting glucose (IFG), newly diagnosed diabetes, diabetes < 5yrs, or diabetes >= 5 years. The occurrence of incident hip fracture was analyzed until 2019.There was a strong inverse relationship between the physical activity level and the risk of hip fractures in both men and women. A lower level of PA (_1500 MET-min/week) was associated with a significantly lower risk of hip fractures. This inverse association between PA and risk of hip fracture was consistently observed across all five groups classified by their glycemic status. Furthermore, the benefit of PA in the prevention of hip fracture was shown to be greatest in subjects with diabetes >= 5 years (adjusted hazard ratio [aHR] and 95% confidence interval [CI], 0.74 [0.62 to 0.88] in men and 0.74 [0.62-0.89] in women) and then gradually decreased in the order of diabetes < 5yrs, newly diagnosed diabetes, IFG or NGT.Higher PA levels decrease the risk of fractures in both men and women. This protective effect of PA on fracture risk is greatest in diabetic subjects and even higher in subjects with diabetic patients 5 years or longer. Our results suggest that increasing the frequency of PA after diagnosis of T2DM may lower the risk of hip fracture.