Magnus Tveit

Former Male Elite Athletes Have a Higher Prevalence of Osteoarthritis and Arthroplasty in the Hip and Knee Than Expected

Background: Intense exercise has been reported as one risk factor for hip and knee osteoarthritis (OA). Purpose: This study aimed to evaluate (1) whether this is true for both former impact and nonimpact athletes, (2) if the risk of a hip or knee arthroplasty due to OA is higher than expected, and (3) if joint deterioration is associated with knee injuries. Study Design: Cohort study; Level of evidence, 3. Methods: The prevalence of OA and arthroplasty in the hip and knee were registered in 709 former male elite athletes with a median age of 70 years (range, 50-93 years), retired from sports for a median 35 years (range, 1-63 years), and compared with 1368 matched controls. Odds ratios (ORs) are presented as means with 95% confidence intervals (95% CIs). Results: The risk of hip or knee OA was higher in former athletes (OR, 1.9; 95% CI, 1.5-2.3), as was arthroplasty based on OA in either of these joints (OR, 2.2; 95% CI, 1.6-3.1). The risk of hip OA was doubled (OR, 2.0; 95% CI, 1.5-2.8) and hip arthroplasty was 2.5 times higher (OR, 2.5; 95% CI, 1.6-3.7) in former athletes than in controls, predominantly driven by a higher risk in former impact athletes. Also, the risk of knee OA was higher (OR, 1.6; 95% CI, 1.3-2.1), as was knee arthroplasty (OR, 1.6; 95% CI, 0.9-2.7), driven by a higher risk in both former impact and nonimpact athletes. Knee OA in impact athletes was associated with knee injury. Conclusion: Hip and knee OA and hip and knee arthroplasty are more commonly found in former male elite athletes than expected. A previous knee injury is associated with knee OA in former impact athletes but not in nonimpact athletes.

Does a childhood fracture predict low bone mass in young adulthood?—A 27-year prospective controlled study

A fracture in childhood is associated with low bone mineral density (BMD), but it is debated whether a fracture at growth also predicts low BMD in young adulthood. The purpose of this work was to gender‐specifically evaluate whether children with a fracture are at increased risk of low BMD in young adulthood. Distal forearm BMD (g/cm2) was measured with single‐photon absorptiometry (SPA) in 47 boys and 26 girls (mean age 10 years, range 3–16 years) with an index fracture and in 41 boys and 43 girls (mean age 10 years, range 4–16 years) with no fracture. BMD was re‐measured mean 27 years later with the same SPA apparatus and with dual‐energy absorptiometry (DXA), quantitative ultrasound (QUS), and peripheral computed tomography (pQCT). Individual Z‐scores were calculated using the control cohort as reference population. Data are presented as means with 95% confidence intervals (95% CI) within brackets and correlation with Pearsons correlation coefficient. Boys with an index fracture had at fracture event a distal forearm BMD Z‐score of −0.4 (95% CI, −0.7 to −0.1) and at follow‐up −0.4 (95% CI, −0.7 to −0.1). Corresponding values in girls were −0.2 (95% CI, −0.5 to 0.1) and −0.3 (95% CI, −0.7 to 0.1). The deficit in absolute bone mass was driven by men with index fractures in childhood due to low energy rather than moderate or high energy. There were no changes in BMD Z‐score during the follow‐up period. The BMD deficit at follow‐up was in boys with an index fracture verified with all advocated techniques. A childhood fracture in men was associated with low BMD and smaller bone size in young adulthood whereas the deficit in women did not reach statistical significance.

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.

Exercise in youth: High bone mass, large bone size, and low fracture risk in old age

Physical activity is favorable for peak bone mass but if the skeletal benefits remain and influence fracture risk in old age is debated. In a cross‐sectional controlled mixed model design, we compared dual X‐ray absorptiometry‐derived bone mineral density (BMD) and bone size in 193 active and retired male elite soccer players and 280 controls, with duplicate measurements of the same individual done a mean 5 years apart. To evaluate lifetime fractures, we used a retrospective controlled study design in 397 retired male elite soccer players and 1368 controls. Differences in bone traits were evaluated by Students t‐test and fracture risk assessments by Poisson regression and Cox regression. More than 30 years after retirement from sports, the soccer players had a Z‐score for total body BMD of 0.4 (0.1 to 0.6), leg BMD of 0.5 (0.2 to 0.8), and femoral neck area of 0.3 (0.0 to 0.5). The rate ratio for fracture after career end was 0.6 (0.4 to 0.9) and for any fragility fracture 0.4 (0.2 to 0.9). Exercise‐associated bone trait benefits are found long term after retirement from sports together with a lower fracture risk. This indicates that physical activity in youth could reduce the burden of fragility fractures.