Osteoporosis International

, Volume 23, Issue 1, pp 67–74

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

  • L. L. Laslett
  • S. J. Just nee Foley
  • S. J. Quinn
  • T. M. Winzenberg
  • G. Jones
Original Article

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.

Keywords

Obesity Osteoporosis/epidemiology Risk factors Vertebral deformity Vertebral fracture 

References

  1. 1.
    Johnell O, Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726–1733PubMedCrossRefGoogle Scholar
  2. 2.
    Cooper C, O'Neill T, Silman A (1993) The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group. Bone 14:S89–S97PubMedCrossRefGoogle Scholar
  3. 3.
    Ross PD (1997) Clinical consequences of vertebral fractures. Am J Med 103:30S–42S, discussion 42S–43SPubMedCrossRefGoogle Scholar
  4. 4.
    Ferrar L, Jiang G, Adams J, Eastell R (2005) Identification of vertebral fractures: an update. Osteoporos Int 16:717–728PubMedCrossRefGoogle Scholar
  5. 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 18:1617–1624PubMedCrossRefGoogle Scholar
  6. 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 20:1349–1355PubMedCrossRefGoogle Scholar
  7. 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 136:298–304PubMedCrossRefGoogle Scholar
  8. 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 16:1330–1338PubMedCrossRefGoogle Scholar
  9. 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 103:274–280PubMedCrossRefGoogle Scholar
  10. 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 146:287–293PubMedGoogle Scholar
  11. 11.
    Edelstein SL, Barrett-Connor E (1993) Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol 138:160–169PubMedGoogle Scholar
  12. 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 136:257–265PubMedGoogle Scholar
  13. 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 24:1369–1379PubMedCrossRefGoogle Scholar
  14. 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 83:146–154PubMedGoogle Scholar
  15. 15.
    Zhao LJ, Liu YJ, Liu PY, Hamilton J, Recker RR, Deng HW (2007) Relationship of obesity with osteoporosis. J Clin Endocrinol Metab 92:1640–1646PubMedCrossRefGoogle Scholar
  16. 16.
    Reid IR (2008) Relationships between fat and bone. Osteoporos Int 19:595–606PubMedCrossRefGoogle Scholar
  17. 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 23:17–29PubMedCrossRefGoogle Scholar
  18. 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 9:126–136PubMedCrossRefGoogle Scholar
  19. 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) 30:1750–1757CrossRefGoogle Scholar
  20. 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 26:32–38PubMedCrossRefGoogle Scholar
  21. 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 15:2011–2018PubMedCrossRefGoogle Scholar
  22. 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 16:1337–1342PubMedCrossRefGoogle Scholar
  23. 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 25:527–536PubMedCrossRefGoogle Scholar
  24. 24.
    Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J (2010) Obesity and fractures in postmenopausal women. J Bone Miner Res 25:292–297PubMedCrossRefGoogle Scholar
  25. 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 51:857–863PubMedCrossRefGoogle Scholar
  26. 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 28:88–93PubMedCrossRefGoogle Scholar
  27. 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 27:479–484PubMedCrossRefGoogle Scholar
  28. 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):496–502CrossRefGoogle Scholar
  29. 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 6:12–19PubMedGoogle Scholar
  30. 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 114:919–923PubMedGoogle Scholar
  31. 31.
    Flegal KM, Carroll MD, Ogden CL, Curtin LR (2010) Prevalence and trends in obesity among US adults, 1999–2008. JAMA 303:235–241PubMedCrossRefGoogle Scholar
  32. 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):631–638PubMedCrossRefGoogle Scholar
  33. 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 63:140–146PubMedCrossRefGoogle Scholar
  34. 34.
    Eastell R, Cedel SL, Wahner HW, Riggs BL, Melton LJ 3rd (1991) Classification of vertebral fractures. J Bone Miner Res 6:207–215PubMedCrossRefGoogle Scholar
  35. 35.
    MIMS Australia (2009) MIMS annual. CMPMedica, St LeonardsGoogle Scholar
  36. 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 41:383–389PubMedGoogle Scholar
  37. 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 6:233–239PubMedCrossRefGoogle Scholar
  38. 38.
    Daniels SR, Khoury PR, Morrison JA (2000) Utility of different measures of body fat distribution in children and adolescents. Am J Epidemiol 152:1179–1184PubMedCrossRefGoogle Scholar
  39. 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 73:460–468PubMedCrossRefGoogle Scholar
  40. 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 41:5–12PubMedCrossRefGoogle Scholar
  41. 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. 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 8:66–69PubMedCrossRefGoogle Scholar
  43. 43.
    Pollintine P, Luo J, Offa-Jones B, Dolan P, Adams MA (2009) Bone creep can cause progressive vertebral deformity. Bone 45:466–472PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • L. L. Laslett
    • 1
  • S. J. Just nee Foley
    • 1
  • S. J. Quinn
    • 2
  • T. M. Winzenberg
    • 1
  • G. Jones
    • 1
  1. 1.Menzies Research Institute TasmaniaUniversity of TasmaniaHobartAustralia
  2. 2.School of Medicine, Flinders Clinical EffectivenessFlinders UniversityAdelaideAustralia

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