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Influence of Obesity and Changes in Weight or BMI on Incident Fractures in Postmenopausal Women: From Peking Vertebral Fracture Study

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Abstract

This study aims to investigate the influence of overweight/obesity and change in weight or body mass index (BMI) on incident fractures among Chinese postmenopausal women. According to BMI, 754 postmenopausal women were categorized into normal weight (NW), overweight (OW), and obesity (OB) groups, respectively. We used data from the baseline and the second survey for statistical analysis, including anthropometric data, clinical fractures, and morphometric vertebral fractures (MVFs) assessed by X-rays. The prevalence of previous MVFs was 32.7% and 21.8% in the OB and NW groups, respectively (p < 0.05). All incident fractures and incident MVFs accounted for 10.7 and 6.3% among all participants within five years. Overweight/obesity and increase in weight or BMI during the follow-up had no associations with all incident fractures, incident MVFs, and incident clinical non-VFs among all participants. However, after multivariate adjustment, the increased BMI at baseline was the risk factor of incident MVFs in the OW group (odds ratio, OR 2.06, 95% confidence interval, 95% CI 1.16–3.66, p = 0.014), and increase in weight (OR 0.89, 95% CI 0.79–0.99, p = 0.036) or BMI (OR 0.77, 95% CI 0.59–0.99, p = 0.045) during the follow-up were the protective factors of all incident fractures in the NW group. Overweight/obesity and change in weight or BMI do not correlate with fracture risk in postmenopausal women, but an increase in weight is the protective factor against incident fractures in normal-weight participants. Overweight postmenopausal women with a higher BMI should pay attention to the risk of MVFs.

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Data Availability Statement

The raw datasets generated and/or analyzed during this study are not publicly available but are available from the corresponding author on reasonable request.

References

  1. Walsh JS, Vilaca T (2017) Obesity, Type 2 diabetes and bone in adults. Calcif Tissue Int 100:528–535

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Caballero B (2019) Humans against obesity: Who Will Win? Adv Nutr 10:S4–S9

  3. Cui L, Jackson M, Wessler Z, Gitlin M, Xia W (2021) Estimating the future clinical and economic benefits of improving osteoporosis diagnosis and treatment among women in China: a simulation projection model from 2020 to 2040. Arch Osteoporos 16:118

    Article  PubMed  Google Scholar 

  4. Withrow D, Alter DA (2011) The economic burden of obesity worldwide: a systematic review of the direct costs of obesity. Obes Rev 12:131–141

    Article  CAS  PubMed  Google Scholar 

  5. Wang L, Yu W, Yin X, Cui L, Tang S, Jiang N, Cui L, Zhao N, Lin Q, Chen L, Lin H, Jin X, Dong Z, Ren Z, Hou Z, Zhang Y, Zhong J, Cai S, Liu Y, Meng R, Deng Y, Ding X, Ma J, Xie Z, Shen L, Wu W, Zhang M, Ying Q, Zeng Y, Dong J, Cummings SR, Li Z, Xia W (2021) Prevalence of osteoporosis and fracture in China: the China Osteoporosis Prevalence Study. JAMA Netw Open 4:e2121106

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cui L, Chen L, Xia W, Jiang Y, Cui L, Huang W, Wang W, Wang X, Pei Y, Zheng X, Wang Q, Ning Z, Li M, Wang O, Xing X, Lin Q, Yu W, Weng X, Xu L, Cummings SR (2017) Vertebral fracture in postmenopausal Chinese women: a population-based study. Osteoporos Int 28:2583–2590

    Article  CAS  PubMed  Google Scholar 

  7. Zeng Q, Li N, Pan XF, Chen L, Pan A (2021) Clinical management and treatment of obesity in China. Lancet Diabetes Endocrinol 9:393–405

    Article  PubMed  Google Scholar 

  8. Wang Y, Zhao L, Gao L, Pan A, Xue H (2021) Health policy and public health implications of obesity in China. Lancet Diabetes Endocrinol 9:446–461

    Article  PubMed  Google Scholar 

  9. 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 51:857–863

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cherif R, Mahjoub F, Sahli H, Cheour E, Vico L, Sakly M, Attia N (2018) Positive association of obesity and insulin resistance with bone mineral density in Tunisian Postmenopausal Women. J Clin Densitom 21:163–171

    Article  PubMed  Google Scholar 

  11. Rinonapoli G, Pace V, Ruggiero C, Ceccarini P, Bisaccia M, Meccariello L, Caraffa A (2021) Obesity and bone: a complex relationship. Int J Mol Sci 22

  12. Rikkonen T, Sund R, Sirola J, Honkanen R, Poole KES, Kröger H (2021) Obesity is associated with early hip fracture risk in postmenopausal women: a 25-year follow-up. Osteoporos Int 32:769–777

    Article  CAS  PubMed  Google Scholar 

  13. Kim J, Lee S, Kim SS, Lee JP, Kim JS, Jung JG, Yoon SJ, Kim KP, Park CK, Kim YH (2021) Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008–2009 (KNHANES IV). BMC Womens Health 21:60

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sadeghi O, Saneei P, Nasiri M, Larijani B, Esmaillzadeh A (2017) Abdominal obesity and risk of hip fracture: a systematic review and meta-analysis of prospective studies. Adv Nutr 8:728–738

  15. Prieto-Alhambra D, Premaor MO, Fina Avilés F, Hermosilla E, Martinez-Laguna D, Carbonell-Abella C, Nogués X, Compston JE, Díez-Pérez A (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27:294–300

    Article  PubMed  Google Scholar 

  16. Premaor MO, Compston JE, Fina Avilés F, Pagès-Castellà A, Nogués X, Díez-Pérez A, Prieto-Alhambra D (2013) The association between fracture site and obesity in men: a population-based cohort study. J Bone Miner Res 28:1771–1777

    Article  PubMed  Google Scholar 

  17. Yi SW, Bae JH, Kim YM, Won YJ, Kim SH (2022) Relationship between body mass index and fracture risk at different skeletal sites: a nationwide cohort study. Arch Osteoporos 17:99

    Article  PubMed  Google Scholar 

  18. Leslie WD, Schousboe JT, Morin SN, Martineau P, Lix LM, Johansson H, McCloskey EV, Harvey NC, Kanis JA (2020) Measured height loss predicts incident clinical fractures independently from FRAX: a registry-based cohort study. Osteoporos Int 31:1079–1087

    Article  CAS  PubMed  Google Scholar 

  19. LeBlanc ES, Rizzo JH, Pedula KL, Yaffe K, Ensrud KE, Cauley JA, Cawthon PM, Cummings SR, Hillier TA (2018) Long-term weight trajectory and risk of hip fracture, falls, impaired physical function, and death. J Am Geriatr Soc 66:1972–1979

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crandall CJ, Yildiz VO, Wactawski-Wende J, Johnson KC, Chen Z, Going SB, Wright NC, Cauley JA (2015) Postmenopausal weight change and incidence of fracture: post hoc findings from Women’s Health Initiative Observational Study and Clinical Trials. BMJ 350:h25

    Article  PubMed  PubMed Central  Google Scholar 

  21. Jiajue R, Qi X, Jiang Y, Wang Q, Wang W, Pei Y, Wang X, Huang W, Zheng X, Ning Z, Wang O, Li M, Xing X, Yu W, Xu L, Xia W (2019) Incident fracture risk in Type 2 diabetic postmenopausal women in Mainland China: Peking Vertebral Fracture Study. Calcif Tissue Int 105:466–475

    Article  CAS  PubMed  Google Scholar 

  22. Zhao J, Xia W, Nie M, Zheng X, Wang Q, Wang X, Wang W, Ning Z, Huang W, Jiang Y, Li M, Wang O, Xing X, Sun Y, Luo L, He S, Yu W, Lin Q, Pei Y, Zhang F, Han Y, Tong Y, Che Y, Shen R, Hu Y, Zhou X, Xu L (2011) The levels of bone turnover markers in Chinese postmenopausal women: Peking Vertebral Fracture study. Menopause 18:1237–1243

  23. Zhao J, Xia W, Nie M, Zheng X, Wang Q, Wang X, Wang W, Ning Z, Huang W, Jiang Y, Li M, Wang O, Xing X, Sun Y, Luo L, He S, Yu W, Lin Q, Pei Y, Zhang F, Han Y, Tong Y, Che Y, Shen R, Hu Y, Zhou X, Chen Q, Xu L (2012) A haplotype of MATN3 is associated with vertebral fracture in Chinese postmenopausal women: Peking Vertebral Fracture (PK-VF) study. Bone 50:917–924

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Chen C, Lu FC (2004) The guidelines for prevention and control of overweight and obesity in Chinese adults. Biomed Environ Sci 17(Suppl):1–36

    PubMed  Google Scholar 

  25. Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  CAS  PubMed  Google Scholar 

  26. Zhang Z, Shen J, Liu Z (2005) Retrospective study on standardization of BMD machines in China. Chin J Osteoporos 133–139+145

  27. Sirola J, Rikkonen T, Tuppurainen M, Honkanen R, Kröger H (2012) Should risk of bone fragility restrict weight control for other health reasons in postmenopausal women?—a ten year prospective study. Maturitas 71:162–168

    Article  PubMed  Google Scholar 

  28. Evans AL, Paggiosi MA, Eastell R, Walsh JS (2015) Bone density, microstructure and strength in obese and normal weight men and women in younger and older adulthood. J Bone Miner Res 30:920–928

    Article  PubMed  Google Scholar 

  29. Sornay-Rendu E, Boutroy S, Vilayphiou N, Claustrat B, Chapurlat RD (2013) In obese postmenopausal women, bone microarchitecture and strength are not commensurate to greater body weight: the Os des Femmes de Lyon (OFELY) study. J Bone Miner Res 28:1679–1687

    Article  CAS  PubMed  Google Scholar 

  30. Qi W, Jiang Y, Liu W, Chi Y, Jiajue R, Pang Q, Wang O, Li M, Xing X, Yu W, Xia W (2022) Bone microarchitecture in obese postmenopausal Chinese Women: the Chinese Vertebral Osteoporosis Study (ChiVOS). Front Endocrinol 13:891413

    Article  Google Scholar 

  31. Greendale GA, Sowers M, Han W, Huang MH, Finkelstein JS, Crandall CJ, Lee JS, Karlamangla AS (2012) Bone mineral density loss in relation to the final menstrual period in a multiethnic cohort: results from the Study of Women’s Health Across the Nation (SWAN). J Bone Miner Res 27:111–118

    Article  PubMed  Google Scholar 

  32. Dequeker J, Aerssens J, Luyten FP (2003) Osteoarthritis and osteoporosis: clinical and research evidence of inverse relationship. Aging Clin Exp Res 15:426–439

    Article  PubMed  Google Scholar 

  33. El Maghraoui A, Sadni S, El Maataoui A, Majjad A, Rezqi A, Ouzzif Z, Mounach A (2015) Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women. Nutr Metab 12:44

    Article  Google Scholar 

  34. Leslie WD, Morin SN, Majumdar SR, Lix LM (2018) Effects of obesity and diabetes on rate of bone density loss. Osteoporos Int 29:61–67

    Article  CAS  PubMed  Google Scholar 

  35. Li G, Compston JE, Leslie WD, Thabane L, Papaioannou A, Lau A, Wang X, Qin C, Chen B, Chen M, Adachi JD (2020) Relationship between obesity and risk of major osteoporotic fracture in postmenopausal women: taking frailty into consideration. J Bone Miner Res 35:2355–2362

    Article  CAS  PubMed  Google Scholar 

  36. Kim H, Lee CW, Nam MJ, Choi YJ, Han K, Jung JH, Kim DH, Park JH (2021) Association between body composite indices and vertebral fractures in pre and postmenopausal women in Korea. PLoS ONE 16:e0254755

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Tanaka S, Kuroda T, Saito M, Shiraki M (2013) Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int 24:69–76

    Article  CAS  PubMed  Google Scholar 

  38. Søgaard AJ, Meyer HE, Ahmed LA, Jørgensen L, Bjørnerem A, Joakimsen RM, Emaus N (2012) Does recalled dieting increase the risk of non-vertebral osteoporotic fractures? The Tromsø Study. Osteoporos Int 23:2835–2845

    Article  PubMed  Google Scholar 

  39. Joakimsen RM, Fønnebø V, Magnus JH, Tollan A, Søgaard AJ (1998) The Tromsø Study: body height, body mass index and fractures. Osteoporos Int 8:436–442

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We are so grateful to all of the participants in this study.

Funding

This study was supported by the National Natural Science Foundation of China (81900811, 81970757, 81900798, 82100946, 81170805, and 81670714), the Chinese National Key Technology R & D Program, Ministry of Science and Technology (2021YFC2501700), and the Chinese Academy of Medical Sciences-CAMS Innovation Fund for Medical Sciences (CIFMS-2021–I2M-1-002).

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Author notes

  1. Hanting Liang and Ruizhi Jiajue contributed equally to this work.

Authors and Affiliations

  1. Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China

    Hanting Liang, Ruizhi Jiajue, Wenting Qi, Yan Jiang, Lijia Cui, Qianqian Pang, Yue Chi, Wei Liu, Ou Wang, Mei Li, Xiaoping Xing & Weibo Xia

  2. Department of Endocrinology, Beijing Liangxiang Hospital, Beijing, 102401, China

    Qiuping Wang

  3. Department Endocrinology, Peking University Shougang Hospital, Beijing, 100144, China

    Wenbo Wang

  4. Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China

    Yu Pei

  5. Department of Cadre Unit, General Hospital of the Second Artillery Force, Beijing, 100088, China

    Xiran Wang

  6. Department of Endocrinology, Beijing Haidian Hospital, Beijing, 100080, China

    Wei Huang

  7. Department of Endocrinology, China Rehabilitation Research Center, Beijing, 100068, China

    Xin Zheng

  8. Department of Endocrinology, Beijing Chaoyang Hospital, Beijing, 100020, China

    Zhiwei Ning

  9. Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China

    Wei Yu

  10. Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China

    Ling Xu

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  1. Hanting Liang
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Contributions

WBX designed the study and revised the manuscript. HTL and RZJ did the statistical analysis, revised the manuscript, and interpreted the results. HTL draft the manuscript. WTQ, QQP, YC, RZJ, LJC, YJ, WL, QPW, WBW, YP, XRW, WH, XZ, ZWN, OW, ML, XPX, WY, and LX collected the data. HTL, RZJ, and WBX are responsible for the integrity of the data analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Weibo Xia.

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Conflict of Interest

Hanting Liang, Ruizhi Jiajue, Wenting Qi, Yan Jiang, Lijia Cui, Qianqian Pang, Yue Chi, Wei Liu, Qiuping Wang, Wenbo Wang, Yu Pei, Xiran Wang, Wei Huang, Xin Zheng, Zhiwei Ning, Ou Wang, Mei Li, Xiaoping Xing, Wei Yu, Ling Xu and Weibo Xia declares no competing interest.

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The study was performed with the approval of the Ethics Committee of Peking Union Medical College Hospital.

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Liang, H., Jiajue, R., Qi, W. et al. Influence of Obesity and Changes in Weight or BMI on Incident Fractures in Postmenopausal Women: From Peking Vertebral Fracture Study. Calcif Tissue Int 113, 483–495 (2023). https://doi.org/10.1007/s00223-023-01129-5

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