Association between abdominal obesity and fragility fractures among elderly Israeli women

  • Orit OfirEmail author
  • Assaf Buch
  • Vanessa Rouach
  • Rebecca Goldsmith
  • Naftali Stern
  • Efrat Monsonego-Ornan
Original Article



Obesity has been traditionally viewed as a protective factor for fractures. Recent studies have challenged this concept, particularly regarding abdominal obesity. We aimed to investigate the association between abdominal obesity, body mass index (BMI) and fragility fractures prevalence in a sample of community-dwelling elderly Israeli women.


The data in this cross-sectional study were based on ‘Mabat Zahav’—a survey of a nationally representative sample of elderly Israelis. The study population included 669 women. Data on fragility fractures site and circumstances were self-reported, and height, weight, waist and calf circumferences were measured. Waist circumference (WC) variable was divided into tertiles: < 88 cm, 88–99 cm and > 99 cm.


Sixty-five women reported fragility fractures (14 hip fractures, 18 vertebral fractures and 39 wrist fractures). Mean age was 73.9 ± 5.9 years, mean BMI was 29.9 ± 5 kg/m2 and mean WC was 93.9 ± 12 cm. While BMI was not associated with osteoporotic fractures, abdominal obesity (WC > 88 cm) was positively associated with fragility fractures, independently of age, smoking, physical activity [middle and high WC tertiles {3.15 (95% CI 1.41–7.02), 2.78 (95% CI 1.05–7.31), respectively}].


Among this sample of elderly women, abdominal obesity was positively associated with fragility fractures, independently of age, smoking, physical activity and BMI. Waist circumference, an easily measured anthropometric indicator, may be useful for assessing the risk of fragility fractures in elderly women, particularly among those with normal or high BMI—a vast population which has been traditionally considered as having lower fracture risk.


Osteoporosis Fragility fractures Abdominal obesity Waist circumference BMI 



This work was performed in fulfillment of the requirements for an MSc degree by Orit Ofir at the Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel. The authors wish to acknowledge the support of: the Israel National Institute for Health Policy and Health Services Research (NIHP 2002/15/A); the Israel Hypertension Society; the Association for the Planning and Development of Services for the Aged in Israel—ESHEL (all supported the original survey).

Author contributions

AB and OO contributed equally to this study. OO conducted the literature review, designed the study, analyzed and interpreted the data, and wrote the manuscript. AB conceived and designed the study, analyzed and interpreted the data, and critically reviewed the manuscript. VR designed the study and critically reviewed the manuscript. RG performed the data collection in the original survey and critically reviewed the manuscript. NS wrote and critically reviewed the manuscript. EMO designed the study and critically reviewed the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Survey was approved by the Ethics Committee of the Chaim Sheba Medical Center and the Ministry of Health.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Robert H Smith Faculty of Agriculture, Food and EnvironmentThe Hebrew University of JerusalemRehovotIsrael
  2. 2.Institute of Endocrinology, Metabolism and HypertensionTel Aviv Sourasky Medical CenterTel-AvivIsrael
  3. 3.The Sackler Faculty of MedicineTel-Aviv UniversityTel-AvivIsrael
  4. 4.Nutrition DivisionMinistry of Health IsraelJerusalemIsrael

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