Women with severe obesity and relatively low bone mineral density have increased fracture risk
- 528 Downloads
Among women with obesity, those with the lowest bone density have the highest fracture risk. The types of fractures include any fracture, fragility-type fractures (vertebra, hip, upper arm, forearm, and lower leg), hand and foot fractures, osteoporotic, and other fracture types.
Recent reports have contradicted the traditional view that obesity is protective against fracture. In this study, we have evaluated the relationship between fracture history and bone mineral density (BMD) in subjects with obesity.
Fracture risk was assessed in 400 obese women in relation to body mass index (BMI), BMD, and clinical and laboratory variables.
Subjects (mean age, 43.8 years; SD, 11.1 years) had a mean BMI of 46.0 kg/m2 (SD, 7.4 kg/m2). There were a total of 178 self-reported fractures in 87 individuals (21.8 % of subjects); fragility-type fractures (hip, vertebra, proximal humerus, distal forearm, and ankle/lower leg) were present in 58 (14.5 %). There were higher proportions of women in the lowest femoral neck BMD quintile who had any fracture history (41.3 vs. 17.2 %, p < 0.0001), any fragility-type fractures (26.7 vs. 11.7 %, p = 0.0009), hand and foot fractures (16.0 vs. 5.5 %, p = 0.002), other fracture types (5.3 vs. 1.2 %, p = 0.02), and osteoporotic fractures (8.0 vs. 1.2 %, p < 0.0001) compared to the remaining population. The odds ratio for any fracture was 0.63 (95 % CI, 0.49–0.89; p = 0.0003) per SD increase in BMD and was 4.3 (95 % CI, 1.9–9.4; p = 0.003) in the lowest BMD quintile compared to the highest quintile. No clinical or biochemical predictors of fracture risk were identified apart from BMD.
Women with obesity who have the lowest BMD values, despite these being almost normal, have an elevated risk of fracture compared to those with higher BMD.
KeywordsFracture risk Fractures Obesity Osteoporosis Women
Conflicts of interest
This study was supported by Canadian Institutes of Health Research grant number 86642.
- 1.De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P, Eisman JA, Kroger H, Fujiwara S, Garnero P, McCloskey EV, Mellstrom D, Melton LJ, Meunier PJ, Pols HA, Reeve J, Silman A, Tenenhouse A (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338PubMedCrossRefGoogle Scholar
- 2.Prieto-Alhambra D, Premaor MO, Fina Aviles F, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C, Nogues X, Compston JE, Diez-Perez A (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27:294–300PubMedCrossRefGoogle Scholar
- 4.Compston JE, Watts NB, Chapurlat R, Cooper C, Boonen S, Greenspan S, Pfeilschifter J, Silverman S, Diez-Perez A, Lindsay R, Saag KG, Netelenbos JC, Gehlbach S, Hooven FH, Flahive J, Adachi JD, Rossini M, Lacroix AZ, Roux C, Sambrook PN, Siris ES, Investigators G (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124:1043–1050PubMedCrossRefGoogle Scholar
- 7.FitzGerald G, Boonen S, Compston JE, Pfeilschifter J, LaCroix AZ, Hosmer DW Jr, Hooven FH, Gehlbach SH, Investigators GLOW (2012) Differing risk profiles for individual fracture sites: evidence from the global longitudinal study of osteoporosis in women (GLOW). J Bone Miner Res 27:1907–1915PubMedCrossRefGoogle Scholar
- 12.World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. World Health Organization Tech Rep Ser 854:1–452Google Scholar
- 15.Padwal RS, Rueda-Clausen CF, Sharma AM, Agborsangaya CB, Klarenbach S, Birch DW, Karmali S, McCargar L, Majumdar SR (2013) Weight loss and outcomes in wait-listed, medically managed, and surgically treated patients enrolled in a population-based bariatric program: prospective cohort study. Med Care 52(3):208–15CrossRefGoogle Scholar
- 21.Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRefGoogle Scholar
- 22.Kanis JA (2014) FRAX. http://www.shef.ac.uk/FRAX/. Accessed Feb 4
- 33.Richards JB, Rivadeneira F, Inouye M, Pastinen TM, Soranzo SG, Andrew T, Falchi M, Gwilliam R, Ahmadi KR, Valdes AM, Arp P, Whittaker P, Verlaan DJ, Jhamai M, Kumanduri V, Moorhouse M, van Meurs JB, Hofman A, Pols HAP, Hart D, Zhai G, Kato BS, Mullin BH, Zhang F, Deloukas P, Uitterlinden AG, Spector TD (2008) Bone mineral density, osteoporosis, and osteoporotic fractures: a genome-wide association study. Lancet 371:1505–1512PubMedCentralPubMedCrossRefGoogle Scholar
- 37.Crepaldi G, Romanato G, Tonin P, Maggi S (2007) Osteoporosis and body composition. J Endocrinol Investig 30:S42–S47Google Scholar
- 40.Hsu YH, Venners SA, Terwedow HA, Feng Y, Niu T, Li Z, Laird N, Brain JD, Cummings SR, Bouxsein ML, Rosen CJ, Xu X (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
- 53.Shields M, Carroll MD, Ogden CL (2011) Adult obesity prevalence in Canada and the United States. NCHS data brief, no 56. National Center for Health Statistics, HyattsvilleGoogle Scholar