Skip to main content
SpringerLink
Log in

Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

Thinness is a risk factor for fractures, but the effect of obesity on fracture risk is less clear. We found an association between measures of obesity and prevalence and number of vertebral deformities in women but not in men, in a cross-sectional study of 1,011 participants aged 50–80 years.

Introduction

Low body weight is well recognised as a risk factor for fractures, but the association between overweight and fracture risk is less well described. This cross-sectional study describes the association between measures of obesity and vertebral deformities in 1,011 male and female participants in the Tasmanian Older Adult Cohort study.

Methods

Vertebral deformities (anterior wedging) of T4–L4 were determined by morphometric dual-emission X-ray absorptiometry. Body fat was assessed as weight, body mass index (BMI), waist–hip ratio (WHR), waist circumference and DXA measures of trunk fat (in percent) and total fat mass.

Results

The mean age of participants was 63 ± 7 years, and mean BMI was 28 ± 5. Prevalent thoracic vertebral deformities were associated with increasing weight [standardised β (Sβ) 0.29, p = 0.003], BMI (Sβ 0.33, p < 0.001), trunk fat (Sβ 0.20, p = 0.03), waist circumference (Sβ 0.19, p = 0.03) and fat mass (Sβ 0.23, p = 0.03), but not the WHR in women, and only with decreasing total fat mass in men. In addition, the number of vertebral deformities increased as weight, BMI or fat mass increased in women (all p < 0.05) but decreased with increasing total fat mass in men. Associations between fat mass and vertebral deformities were mainly linear, but there was some evidence of a threshold effect in women with a BMI ≥35.

Conclusions

There is a deleterious association between increasing amounts of body fat in women but not in men and the prevalence and number of vertebral deformities, which may reflect loading of the thoracic spine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733

    Article  PubMed  CAS  Google Scholar 

  2. Cooper C, O'Neill T, Silman A (1993) The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone 14:S89–S97

    Article  PubMed  Google Scholar 

  3. Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–42S, discussion 42S–43S

    Article  PubMed  CAS  Google Scholar 

  4. Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporos Int 16:717–728

    Article  PubMed  CAS  Google Scholar 

  5. Roux C, Fechtenbaum J, Kolta S, Briot K, Girard M (2007) Mild prevalent and incident vertebral fractures are risk factors for new fractures. Osteoporos Int 18:1617–1624

    Article  PubMed  CAS  Google Scholar 

  6. Pongchaiyakul C, Nguyen ND, Jones G, Center JR, Eisman JA, Nguyen TV (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long-term prospective study. J Bone Miner Res 20:1349–1355

    Article  PubMed  Google Scholar 

  7. Daniell HW (1976) Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med 136:298–304

    Article  PubMed  CAS  Google Scholar 

  8. De Laet C, Kanis JA, Oden A et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338

    Article  PubMed  Google Scholar 

  9. Ensrud KE, Lipschutz RC, Cauley JA, Seeley D, Nevitt MC, Scott J, Orwoll ES, Genant HK, Cummings SR (1997) Body size and hip fracture risk in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Am J Med 103:274–280

    Article  PubMed  CAS  Google Scholar 

  10. Johnell O, O'Neill T, Felsenberg D, Kanis J, Cooper C, Silman AJ (1997) Anthropometric measurements and vertebral deformities. European Vertebral Osteoporosis Study (EVOS) Group. Am J Epidemiol 146:287–293

    PubMed  CAS  Google Scholar 

  11. Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138:160–169

    PubMed  CAS  Google Scholar 

  12. Sowers MF, Kshirsagar A, Crutchfield MM, Updike S (1992) Joint influence of fat and lean body composition compartments on femoral bone mineral density in premenopausal women. Am J Epidemiol 136:257–265

    PubMed  CAS  Google Scholar 

  13. Beck TJ, Petit MA, Wu G, LeBoff MS, Cauley JA, Chen Z (2009) Does obesity really make the femur stronger? BMD, geometry, and fracture incidence in the women's health initiative-observational study. J Bone Miner Res 24:1369–1379

    Article  PubMed  Google Scholar 

  14. Hsu YH, Venners SA, Terwedow HA et al (2006) Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr 83:146–154

    PubMed  CAS  Google Scholar 

  15. Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW (2007) Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 92:1640–1646

    Article  PubMed  CAS  Google Scholar 

  16. Reid IR (2008) Relationships between fat and bone. Osteoporos Int 19:595–606

    Article  PubMed  CAS  Google Scholar 

  17. Zhao LJ, Jiang H, Papasian CJ, Maulik D, Drees B, Hamilton J, Deng HW (2008) Correlation of obesity and osteoporosis: effect of fat mass on the determination of osteoporosis. J Bone Miner Res 23:17–29

    Article  PubMed  CAS  Google Scholar 

  18. Corbeil P, Simoneau M, Rancourt D, Tremblay A, Teasdale N (2001) Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural Syst Rehabil Eng 9:126–136

    Article  PubMed  CAS  Google Scholar 

  19. Berrigan F, Simoneau M, Tremblay A, Hue O, Teasdale N (2006) Influence of obesity on accurate and rapid arm movement performed from a standing posture. Int J Obes (Lond) 30:1750–1757

    Article  CAS  Google Scholar 

  20. Hue O, Simoneau M, Marcotte J, Berrigan F, Dore J, Marceau P, Marceau S, Tremblay A, Teasdale N (2007) Body weight is a strong predictor of postural stability. Gait Posture 26:32–38

    Article  PubMed  Google Scholar 

  21. Goulding A, Jones IE, Taylor RW, Manning PJ, Williams SM (2000) More broken bones: a 4-year double cohort study of young girls with and without distal forearm fractures. J Bone Miner Res 15:2011–2018

    Article  PubMed  CAS  Google Scholar 

  22. Skaggs DL, Loro ML, Pitukcheewanont P, Tolo V, Gilsanz V (2001) Increased body weight and decreased radial cross-sectional dimensions in girls with forearm fractures. J Bone Miner Res 16:1337–1342

    Article  PubMed  CAS  Google Scholar 

  23. Dimitri P, Wales JK, Bishop N (2010) Fat and bone in children: differential effects of obesity on bone size and mass according to fracture history. J Bone Miner Res 25:527–536

    Article  PubMed  Google Scholar 

  24. Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J (2010) Obesity and fractures in postmenopausal women. J Bone Miner Res 25:292–297

    Article  PubMed  Google Scholar 

  25. Kim KC, Shin DH, Lee SY, Im JA, Lee DC (2010) Relation between obesity and bone mineral density and vertebral fractures in Korean postmenopausal women. Yonsei Med J 51:857–863

    Article  PubMed  CAS  Google Scholar 

  26. Pirro M, Fabbriciani G, Leli C, Callarelli L, Manfredelli MR, Fioroni C, Mannarino MR, Scarponi AM, Mannarino E (2010) High weight or body mass index increase the risk of vertebral fractures in postmenopausal osteoporotic women. J Bone Miner Metab 28:88–93

    Article  PubMed  Google Scholar 

  27. Gnudi S, Sitta E, Lisi L (2009) Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Metab 27:479–484

    Article  PubMed  Google Scholar 

  28. Nielson CM, Marshall LM, Adams AL, Leblanc ES, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES (2010) BMI and fracture risk in older men: the osteoporotic fractures in men (MrOS) study. J Bone Miner Res 26(3):496–502

    Article  Google Scholar 

  29. Owusu W, Willett W, Ascherio A, Spiegelman D, Rimm E, Feskanich D, Colditz G (1998) Body anthropometry and the risk of hip and wrist fractures in men: results from a prospective study. Obes Res 6:12–19

    PubMed  CAS  Google Scholar 

  30. Ross PD, Davis JW, Epstein RS, Wasnich RD (1991) Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med 114:919–923

    PubMed  CAS  Google Scholar 

  31. Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241

    Article  PubMed  CAS  Google Scholar 

  32. Walls HL, Wolfe R, Haby MM, Magliano DJ, de Courten M, Reid CM, McNeil JJ, Shaw J, Peeters A (2009) Trends in BMI of urban Australian adults, 1980–2000. Public Health Nutr 13(5):631–638

    Article  PubMed  Google Scholar 

  33. Zaninotto P, Head J, Stamatakis E, Wardle H, Mindell J (2009) Trends in obesity among adults in England from 1993 to 2004 by age and social class and projections of prevalence to 2012. J Epidemiol Community Health 63:140–146

    Article  PubMed  CAS  Google Scholar 

  34. Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215

    Article  PubMed  CAS  Google Scholar 

  35. MIMS Australia (2009) MIMS annual. CMPMedica, St Leonards

  36. Scott D, Blizzard L, Fell J, Jones G (2009) Ambulatory activity, body composition, and lower-limb muscle strength in older adults. Med Sci Sports Exerc 41:383–389

    PubMed  Google Scholar 

  37. Jones G, White C, Nguyen T, Sambrook PN, Kelly PJ, Eisman JA (1996) Prevalent vertebral deformities: relationship to bone mineral density and spinal osteophytosis in elderly men and women. Osteoporos Int 6:233–239

    Article  PubMed  CAS  Google Scholar 

  38. Daniels SR, Khoury PR, Morrison JA (2000) Utility of different measures of body fat distribution in children and adolescents. Am J Epidemiol 152:1179–1184

    Article  PubMed  CAS  Google Scholar 

  39. Pouliot MC, Despres JP, Lemieux S, Moorjani S, Bouchard C, Tremblay A, Nadeau A, Lupien PJ (1994) Waist circumference and abdominal sagittal diameter: best simple anthropometric indexes of abdominal visceral adipose tissue accumulation and related cardiovascular risk in men and women. Am J Cardiol 73:460–468

    Article  PubMed  CAS  Google Scholar 

  40. Ferrar L, Jiang G, Armbrecht G, Reid DM, Roux C, Gluer CC, Felsenberg D, Eastell R (2007) Is short vertebral height always an osteoporotic fracture? The Osteoporosis and Ultrasound Study (OPUS). Bone 41:5–12

    Article  PubMed  CAS  Google Scholar 

  41. Ferrar L, Roux C, Reid DM, Felsenberg D, Gluer CC, Eastell R (2011) Prevalence of non-fracture short vertebral height is similar in premenopausal and postmenopausal women: the osteoporosis and ultrasound study. Osteoporos Int. doi:10.1007/s00198-011-1657-3

  42. Lyritis GP, Mayasis B, Tsakalakos N, Lambropoulos A, Gazi S, Karachalios T, Tsekoura M, Yiatzides A (1989) The natural history of the osteoporotic vertebral fracture. Clin Rheumatol 8:66–69

    Article  PubMed  Google Scholar 

  43. Pollintine P, Luo J, Offa-Jones B, Dolan P, Adams MA (2009) Bone creep can cause progressive vertebral deformity. Bone 45:466–472

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We especially thank the participants who made this study possible, and we gratefully acknowledge the role of TasOAC staff and volunteers in collecting the data, particularly research nurses Catrina Boon and Pip Boon. Tisha Carter and Rose Ford conducted the densitometry. We thank the Health IT team, particularly Tim Albion and Alistair Chilcott for their expertise in converting the MXA data into a useable format.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia

    L. L. Laslett, S. J. Just nee Foley, T. M. Winzenberg & G. Jones

  2. School of Medicine, Flinders Clinical Effectiveness, Flinders University, Adelaide, Australia

    S. J. Quinn

Authors
  1. L. L. Laslett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. J. Just nee Foley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. J. Quinn
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. M. Winzenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. L. Laslett.

Additional information

The TasOAC study was supported by the National Health and Medical Research Council of Australia, Arthritis Foundation of Australia, Tasmanian Community Fund, Masonic Centenary Medical Research Foundation, Royal Hobart Hospital Research Foundation, and University of Tasmania Institutional Research Grants Scheme. Laura Laslett is supported by an Australian Government Australian Postgraduate Award during her doctoral candidature. She received a travel grant to present this work to the Australian and New Zealand Bone and Mineral Society Annual Scientific Meeting in 2010. Graeme Jones is a National Health and Medical Research Council practitioner fellow. Tania Winzenberg is supported by the Osteoporosis Australia Australian and New Zealand Bone and Mineral Society/Amgen Fellowship. Stella Just (nee Foley) is supported by the Australian Government Australian Postgraduate Award and the Ruby Menzies Scholarship.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Laslett, L.L., Just nee Foley, S.J., Quinn, S.J. et al. Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporos Int 23, 67–74 (2012). https://doi.org/10.1007/s00198-011-1741-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-011-1741-8

Keywords

Search

Navigation