Osteoporosis International

, Volume 28, Issue 7, pp 2137–2146 | Cite as

Association between obesity and femoral neck strength according to age, sex, and fat distribution

  • H. Kim
  • S. H. LeeEmail author
  • B. J. Kim
  • J. M. Koh
Original Article



Indicators of total and abdominal obesity were negatively associated with femoral neck strength indices. There are age-, sex-, and fat distribution-specific differences in the magnitude of these associations. These suggested that indicators of obesity with different magnitude according to age, sex, and fat distribution associated with poor bone health.


Fat regulates bone metabolism, but the associations of total and abdominal obesity with bone health are inconsistent. We investigated the association between indicators of obesity and composite indices of femoral neck (FN) strength reflecting the risk of hip fracture.


This population-based cross-sectional study examined data from the Korea National Health and Nutrition Examination Surveys. Participants were divided into groups according to age (25–49/≥50 years) and sex. We examined total fat mass (TFM) and percentage fat mass (pFM) as indicators of total obesity and truncal fat mass (TrFM) as an indicator of abdominal obesity. We calculated the composite indices of FN strength and anthropometric clinical indicators of abdominal obesity.


TFM, pFM, and TrFM were negatively associated with the composite indices, irrespective of age and sex (P < 0.001–0.005). Most anthropometric clinical indicators of abdominal obesity showed negative associations with the composite indices regardless of age and sex (P < 0.001–0.048), except for women aged 25–49 years. In men, magnitudes of the negative contributions of TFM to the composite indices were significantly stronger at age 25–49 years than at age ≥50 years. Magnitudes of negative associations of TFM with the composite indices were greater in men than in women. TrFM had a more detrimental effect than TFM on FN strength in men aged 25–49 years and in women of both ages.


Indicators of total and abdominal obesity negatively associated with FN strength, and magnitudes of their effects on bone health differed according to age, sex, and fat distribution.


Bone strength Fat distribution Femoral neck strength Obesity Osteoporosis 



Bone mineral density


Femoral neck


Femoral neck width


Hip axis length


Fat mass


Total fat mass


Percentage fat mass


Truncal fat mass


Korea National Health and Nutrition Examination Surveys


Estimated glomerular filtration rate


Waist circumference


Body mass index




High-density lipoprotein cholesterol


25-Hydroxyvitamin D


Dual-energy X-ray absorptiometry


Hip structure analysis


Visceral adiposity index

C index

Conicity index


Waist-to-height ratio


Strength index


Variance inflation factor



This study was supported by a grant (2014-1215) from the Asan Institute for Life Sciences, Seoul, Republic of Korea, and by a grant from the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (project no.: HI14C2258).

Compliance with ethical standards

Informed consent

All participants in the KNHANES survey provided informed consent.

Conflict of interest


Supplementary material

198_2017_4015_MOESM1_ESM.doc (50 kb)
ESM 1 (DOC 49 kb).
198_2017_4015_MOESM2_ESM.doc (60 kb)
ESM 2 (DOC 59 kb).


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  1. 1.Division of Endocrinology and Metabolism, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  2. 2.Division of Endocrinology and Metabolism, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

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