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Association of bone fracture with 30-year body mass index (BMI) trajectories: findings from the Framingham Heart Study

Bone fracture and 30-year BMI trajectories

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Abstract

Summary

A knowledge gap exists in associating later life’s osteoporotic fracture and middle adulthood’s BMI trajectories. We observed an association showing those transitioning from overweight to normal weight face a higher fracture risk in late adulthood, emphasizing the potential benefits of maintaining a stable BMI to reduce late-life fractures.

Purpose

Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood.

Methods

This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35–64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression.

Results

The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see “Methods” for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13–4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern.

Conclusions

This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life.

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Funding

This work is in part supported by the following grants: NIH R01DK122503, R01AG065299, and R01 AR041398.

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Authors and Affiliations

  1. Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA

    Zihao Xin, Hanfei Xu, Xiaoyu Zhang & Ching-Ti Liu

  2. Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA

    Elizabeth J. Samelson & Douglas P. Kiel

  3. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Elizabeth J. Samelson & Douglas P. Kiel

  4. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Elizabeth J. Samelson & Douglas P. Kiel

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  1. Zihao Xin
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Correspondence to Ching-Ti Liu.

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Conflicts of interest

Douglas P. Kiel has received research grants from Amgen and Solarea Bio. He serves on a DSMB for Agnovos, and on scientific advisory boards for Pfizer, Amgen, Reneo, and Solarea Bio. He has received royalties for publication by Wolters-Kluwer for UpToDate. Zihao Xin, Hanfei Xu, Xiaoyu Zhang, Elizabeth J. Samelson, and Ching-Ti Liu declare that they have no conflict of interest.

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Xin, Z., Xu, H., Zhang, X. et al. Association of bone fracture with 30-year body mass index (BMI) trajectories: findings from the Framingham Heart Study. Osteoporos Int (2024). https://doi.org/10.1007/s00198-024-07068-7

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