Youth Fitness & Fracture Risk Later in Life

by Hayden-William June 29, 2026

Time to Read: ~5 Minutes

From the Archives: This is an original (pre-2021) SFF blog post that has been reposted with updated information.

Take Home Points:

Whether physical activity early on in life protects against fracture risk later in life has not been well studied.
A 2013 study found that individuals with no reported fractures later in life were more physically fit when younger (they had greater strength and aerobic capacity).
No studies on this particular topic appear to have been published since the 2013 study.
Two studies examining older adults as they age found that increased physical activity when older is associated with reduced fracture risk during later follow-up times.
Taken together, it appears that being more physically fit (active) at any age may reduce fracture risk later in life.

Background

There has been some ambiguity in the literature as to whether physical activity when you are young remains or has benefit to an individual’s skeletal health when older. Largely, this has been due to study design limitations – it’s hard to follow individuals from young adulthood to middle-age or later. However, in a study by Nordstrom et al., 2013 (PMID: 23184669) the authors did just that. They examined over 450,000 Swedish men from young adulthood (as early as 18 years of age) to later in life (11-41 years later) and examined the relationship between their young adult physical fitness and the number of fractures accumulated later in life.

The Study Design

There are some limitations in this study. First, it only examines men, so the results may not be applicable to women. Also, physical fitness was defined in very specific and somewhat limited ways. Aerobic capacity was measured using a bicycle ergometer test and muscle strength was measured only by knee extension, elbow flexion, and handgrip tests with dynamometers. Further, the follow-up timeframe for examining the men “later in life” was variable, spanning 11 to 41 years after they began the study at 18 years. So, the study is examining fractures that occur from between 18 years and an endpoint of 29 to 59. This is a fairly big age range and consists of a skeletally mixed population; there are young adults (29 years) as well as adults nearing the status of elderly (59 years). This is important because young adults generally fracture from high energy events (i.e., sports trauma) whereas the elderly generally fracture because of low energy falls due to their compromised bone structure (i.e., osteoporosis). Given that this study examined men younger than 65+, it is hard to make iron-clad claims as to whether the benefits of exercise will protect against the 65+ years age-related fractures, which turn out to be of the greatest concern clinically (fractures in young adults generally heal very well).

Study Results

Limitations aside, the results of this study are quite impressive. Even with the abovementioned variability, the authors found very strong correlations. Specifically, the authors found that subjects who did not sustain a fracture by the time of follow-up had significantly greater hand grip strength, elbow flexion strength, knee extension strength, and aerobic capacity at baseline (18 years). Adjusting for confounders, the authors found that for all measures of muscle strength and physical fitness, the risk of fracture increased in a dose-dependent manner. Thus, the lower the levels of muscular strength and aerobic capacity, the greater the participant’s risk of fracture later on. In addition, the effects of muscle strength and aerobic capacity on fracture incidence were independent of each other (by controlling for one of these, the other still was correlated with fracture risk). Another interesting component of this study was the ability to use data from twins to assess heritability. In doing so the authors found that 35-62% of the variation in muscle strength and 78% of the variation in aerobic capacity could be attributed to genetic factors. This is further support for the notion that there is ample room to develop one’s muscular strength and aerobic capacity beyond any given genetic “set point.”

I spend a lot of time bringing studies down to earth and reigning in the over-interpretation that surrounds them in the media, so it’s nice to come across a well conducted study and give it some press. Of course, this study is by no means perfect, and as is often the case it deals with correlations and not causality, but the data is strong and thought-provoking. The fitness you build for yourself when you are young, may very well stave off future instances of fracture.

New Studies Since 2013

As of this update (June 2026) I haven't been able to find any additional studies with the specific comparison of younger fitness levels influencing fracture risk later in life. However, there are two studies with a tangential relation:

Stattin et al., 2017 (PMID: 28460152): In this study over 30,000 Swedish women and over 40,000 Swedish men were followed for 17 years with self-reported exercise data. The participants were followed from a starting baseline age of anywhere from ~43 to ~83 years of age. So, this was not a true youth vs older adult comparison. Nonetheless, the study found that those individuals who walked or bicycled at least some amount less than 20 minutes per day were less likely to have hip fractures (or any fracture) than those who hardly walked or cycled at all. Similarly those who exercised 1 hour a week had a lower risk of hip fracture than those who exercised less than 1 hour each week.

Han et al., 2020 (PMID: 33004986): Here again the focus was on oder adults (40 years or older) and how their physical activity correlated with fracture risk. Over 4 million Korean adults were monitored from 2009 to 2012. There were two medical assessments during this timeframe, during which a medical practitioner asked 7 questions to determine the amount and duration of physical activity performed in the past 7 days. This data was then analyzed in comparison to fracture data from the 2013-2016 follow-up period. The results demonstrated that individuals who had continuous levels of physical activity or levels that decreased but were not zero, had reduced fracture risk compared to those individuals who continuously engaged in no physical activity.

Final Thoughts

As you can see we have a limited number of studies examining the extent to which physical fitness early on in life can reduce fracture risk later in life, but the Nordstrom paper does support this. If we pair this with studies indicating that greater physical fitness later in life can help prevent fractures during this same later period of life, we have a reasonable basis to claim that physical activity conducted at any point in time will yield at least some future benefit to fracture risk reduction. In short, when it comes to reaping the benefit of reduced fracture risk from increased physical activity, it's likely never too early and never too late to obtain some benefit.