Association of walking and osteoporosis risk among 432,493 UK participants: A prospective cohort study.

OBJECTIVE: This study aimed to investigate the optimal dosage of walking duration for osteoporosis prevention. STUDY DESIGN: This study represents a prospective cohort analysis based on data derived from the UK Biobank. METHODS: Utilizing prospective data from the UK Biobank (n = 432,493), we analyzed osteoporosis incidence in adults aged 38-73 years. Walking duration was assessed via validated questionnaires. Cox proportional hazards models adjusted for demographics, comorbidities, and lifestyle factors. Restricted cubic splines characterized nonlinear associations. RESULTS: Participants in all walking groups exhibited significantly lower osteoporosis risk versus the non-walking group. In fully adjusted models, the hazard ratios (HR) (95% confidence intervals) for osteoporosis were: 0.72 (0.65-0.79; P < 0.001) for the <180 min/week of walking group, 0.73 (0.65-0.81; P < 0.001) for the 180-360 of walking group, and 0.74 (0.67-0.83; P < 0.001) for the >360 min/week of walking group, respectively. A U-shaped dose-response relationship was demonstrated (P for nonlinearity <0.001). CONCLUSION: Regular walking demonstrates significant osteoporosis protection, with optimal benefits at 180-360 min/week. This aligns with global physical activity guidelines while revealing an upper threshold beyond which additional walking yields no further risk reduction. Our findings support tailored exercise prescriptions for osteoporosis prevention.