Former male elite athletes have lower incidence of fragility fractures than expected.

Purpose: Physical activity during growth is associated with high peak bone mass and may, as a result, prevent osteoporosis later in life. It is therefore possible that athletic activity during youth could lower the risk of fragility fractures in old age. Although this is currently unclear and based on evaluations of surrogate skeletal end point variables in former athletes, we hypothesized that this is not the case.

Methods: In a retrospective matched controlled cohort study design, we calculated the lifetime incidence of fractures from the results of a mailed questionnaire sent to 709 former male elite athletes with a mean age of 69 yr (range = 50-93 yr) who had given up regular sports activity a mean of 34 yr (range = 1-63 yr) earlier, and to 1368 matched controls. Estimates of time to first fracture were analysed using Poisson regression, and for analyses of covariance, Cox Regression was used. Data are presented as rate ratios (RR) with 95% confidence interval (CI).

Results: After retirement from sports, the former athletes had an RR of 0.70 (0.52-0.93) for any fracture, an RR of 0.50 (0.27-0.89) for any fragility fracture, and an RR of 0.29 (0.09-0.74) for distal radius fractures. When adjusting for occupation, smoking, alcohol, disease, and medication the hazard ratio (HR) of any fracture after an active career was 0.73 (95% CI = 0.54-0.99) and the hazard ratio of any fragility fracture after age 50 yr was 0.63 (95% CI = 0.35-1.16).

Conclusions: In men, elite sports during adolescence are associated with a lower fracture risk after career end. The former athletes were overall healthier, which may have influenced the results.