Abstract
Background
This systematic review examines the relationship between habitual physical activity (PA) in mid-life and fracture outcomes.
Objectives
To determine whether habitual physical activity undertaken in mid-life is associated with the risk of fractures occurring at any later time.
Methods
We searched PubMed, CINAHL, and Embase (from inception to May 2025) and included non-experimental studies reporting a relationship between habitual physical activity undertaken in mid-life and a subsequent fracture. Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty of evidence was established with the GRADE approach.
Results
From 1779 abstracts, we included 10 cohort studies and 3 case-control studies. There was high variation in how physical activity was measured and categorised across studies, limiting comparability. Due to study heterogeneity in exposure and outcome reporting, we conducted a synthesis without meta-analysis (SWIM). Following the GRADE approach, we found low certainty of evidence for a protective effect of moderate activity in mid-life on hip fracture in men (n = 2) and moderate certainty of evidence for a protective effect of high physical activity in mid-life on hip fracture in women (n = 4). There was very low certainty of evidence for the effect of either moderate or high activity on other types of fracture outcomes in men or women (n = 3). Qualitative review of two large studies of moderate to high quality provided further support for these findings.
Conclusions
The temporal relationship between physical activity intensity in mid-life and subsequent fracture risk remains unclear. Further studies using device-measured physical activity and detailed time-to-event data are required.
This systematic review examines the relationship between habitual physical activity (PA) in mid-life and fracture outcomes.
Objectives
To determine whether habitual physical activity undertaken in mid-life is associated with the risk of fractures occurring at any later time.
Methods
We searched PubMed, CINAHL, and Embase (from inception to May 2025) and included non-experimental studies reporting a relationship between habitual physical activity undertaken in mid-life and a subsequent fracture. Risk of bias was assessed using the Newcastle–Ottawa Scale, and certainty of evidence was established with the GRADE approach.
Results
From 1779 abstracts, we included 10 cohort studies and 3 case-control studies. There was high variation in how physical activity was measured and categorised across studies, limiting comparability. Due to study heterogeneity in exposure and outcome reporting, we conducted a synthesis without meta-analysis (SWIM). Following the GRADE approach, we found low certainty of evidence for a protective effect of moderate activity in mid-life on hip fracture in men (n = 2) and moderate certainty of evidence for a protective effect of high physical activity in mid-life on hip fracture in women (n = 4). There was very low certainty of evidence for the effect of either moderate or high activity on other types of fracture outcomes in men or women (n = 3). Qualitative review of two large studies of moderate to high quality provided further support for these findings.
Conclusions
The temporal relationship between physical activity intensity in mid-life and subsequent fracture risk remains unclear. Further studies using device-measured physical activity and detailed time-to-event data are required.
| Original language | English |
|---|---|
| Number of pages | 12 |
| Journal | Osteoporosis International |
| Early online date | 18 Nov 2025 |
| DOIs | |
| Publication status | E-pub ahead of print - 18 Nov 2025 |
Bibliographical note
Publisher Copyright:© The Author(s), under exclusive licence to the International Osteoporosis Foundation and the Bone Health and Osteoporosis Foundation 2025.