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Bone Structure and Estimated Bone Strength in Obese Patients Evaluated by High-Resolution Peripheral Quantitative Computed Tomography

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Abstract

Obesity is associated with high bone mineral density (BMD), but whether obesity-related higher bone mass increases bone strength and thereby protect against fractures is uncertain. We estimated effects of obesity on bone microarchitecture and estimated strength in 36 patients (12 males and 24 females, age 25–56 years and BMI 33.2–57.6 kg/m2) matched with healthy controls (age 25–54 years and BMI 19.5–24.8 kg/m2) in regard to gender, menopausal status, age (±6 years) and height (±6 cm) using high resolution peripheral quantitative computed tomography and dual energy X-ray absorptiometry. In radius, total bone area and trabecular area were significantly higher in obese patients (both p < 0.04). In tibia, cortical area was larger in obese patients (p < 0.001) compared with controls. Total BMD was higher in tibia (p = 0.03) but not in radius. Trabecular integrity was strengthened in obese patients compared with controls in radius and tibia with higher trabecular number (p = 0.002 and p < 0.001) and lower trabecular spacing (p = 0.01 and p < 0.001). Finite element analysis estimated failure load (FL) was higher in tibia (p < 0.001), but not in radius in obese patients. FL was significantly lower per kg body weight in radius and tibia in obese patients compared with controls (p = 0.007 and p < 0.001). Furthermore, the ratios of FLs between groups were comparable in both sites. These findings suggest that mechanical loading is not the primary mediator of the effects of obesity on estimated FL, and suggest that bone strength adaptations in morbid obesity may be inadequate with respect to the increased mechanical demands.

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Acknowledgments

Thanks to Peter Hartmund Jørgensen for competent statistical support. Thanks to Steffanie Anthony-Christensen for patient management and the staff at the Osteoporosis Clinic, Odense University Hospital for technical assistance. This work has received grants from the Region of Southern Denmark.

Human and Animal Rights and Informed Consent

All participants provided written informed consent before inclusion, and the study was approved by The Regional Scientific Ethical Committee for Southern Denmark (file no. 2011-0050 and 2009-0069).

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Authors and Affiliations

  1. Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark

    Stine Andersen, Katrine Diemer Frederiksen, Stinus Hansen, Kim Brixen & René Klinkby Støving

  2. University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark

    Stinus Hansen

  3. Department of Endocrinology, Hospital of Southwest Denmark, Finsensgade 35, 6700, Esbjerg, Denmark

    Stinus Hansen & Jeppe Gram

  4. Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark

    Kim Brixen

  5. Center for Eating Disorders, Odense University Hospital, Kløvervænget 6, 8. sal, 5000, Odense C, Denmark

    René Klinkby Støving

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  1. Stine Andersen
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Correspondence to Katrine Diemer Frederiksen.

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The contribution of Stine Andersen and Katrine Diemer Frederiksen should be considered equal.

Authors Stine Andersen, Katrine Diemer Frederiksen, Jeppe Gram, Stinus Hansen and René Klinkby Støving state that they have no conflicts of interest. Author Kim Brixen has received lecture fees from Eli Lilly, Novartis, Servier, Amgen and GlaxoSmithKline, consulting fees from MSD and investigator payments from MSD, Novartis, Amgen and NPS.

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Andersen, S., Frederiksen, K.D., Hansen, S. et al. Bone Structure and Estimated Bone Strength in Obese Patients Evaluated by High-Resolution Peripheral Quantitative Computed Tomography. Calcif Tissue Int 95, 19–28 (2014). https://doi.org/10.1007/s00223-014-9857-4

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  • DOI: https://doi.org/10.1007/s00223-014-9857-4

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