Abstract
Summary
We conducted a meta-analysis of prospective studies to assess the association between BMI and incident vertebral fracture. We found that as body mass index (BMI) increases, the risk of vertebral fracture decreases in men, but not in women, suggesting possible gender differences in the relationship of BMI with risk of vertebral fracture.
Introduction
Recent evidence suggests that the relationship between BMI and fracture risk may be site-specific. We conducted a systematic review and meta-analysis of prospective studies to investigate the association between BMI and risk of incident vertebral fracture.
Methods
PubMed and Embase were searched for relevant articles published from inception through February 15, 2017. Extracted relative risks (RR) from the prospective studies were pooled using random-effects meta-analysis.
Results
Six studies were included, with a total of 105,129 participants followed for 3 to 19 years. The pooled RR (95% confidence interval [CI]) for vertebral fracture per each standard deviation increase in BMI was 0.94 (95% CI = 0.80–1.10) with significant heterogeneity (I 2 = 88.0%, p < 0.001). In subgroup analysis by gender, we found a significant inverse association between BMI and risk of vertebral fracture in men (RR = 0.85, 95% CI = 0.73–0.98, n = 25,617 participants) but not in women (RR = 0.98, 95% CI = 0.81–1.20, n = 79,512 participants). Across studies of women not adjusting for bone mineral density (BMD), there was no significant association between BMI and risk of vertebral fracture (RR = 0.91, 95% CI = 0.80–1.04, p = 0.18, n = 72,755 participants). However, BMI was associated with an increased risk of vertebral fracture in studies of women that adjusted for BMD (RR = 1.28, 95% CI = 1.17–1.40, p < 0.001, n = 6757 participants). Substantial heterogeneity was found among studies of women (I 2 = 90.1%, p < 0.001), which was partly explained by the adjustment for BMD (adjusted R 2 = 61%). We found no evidence of publication bias (p = 0.40).
Conclusions
In conclusion, our findings suggest that there might be gender differences in the relationship of BMI with risk of vertebral fracture. Further research is needed, including the assessment of other measures of adiposity, such as visceral adiposity, on the risk of vertebral fracture.
Similar content being viewed by others
References
Cauley JA, Hochberg MC, Lui LY, Palermo L, Ensrud KE, Hillier TA, Nevitt MC, Cummings SR (2007) Long-term risk of incident vertebral fractures. JAMA 298:2761–2767
Nevitt MC, Ettinger B, Black DM, Stone K, Jamal SA, Ensrud K, Segal M, Genant HK, Cummings SR (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128:793–800
Gold DT (1996) The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 18:185S–189S
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A (2007) Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res Off J Am Soc Bone Miner Res 22:465–475
Lr M (2003) Adverse outcomes of osteoporotic fractures in the general population. J Bone Miner Res 18:1139–1141
Lr M, Kallmes D (2006) Epidemiology of vertebral fractures: implications for vertebral augmentation. Acad Radiol 13:538–545
Delmas P, Genant H, Crans G, Stock J, Wong M, Siris E, Adachi J (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone 33:522–532
Melton LJ 3rd (1997) Epidemiology of spinal osteoporosis. Spine (Phila Pa 1976) 22:2S–11S
Melton LJ 3rd, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL (1989) Epidemiol Vertebral Fract Women. Am J Epidemiol 129:1000–1011
Cummings SR, Melton LJ (2002) Epidemiology and outcomes of osteoporotic fractures. Lancet 359:1761–1767
Christiansen BA, Bouxsein ML (2010) Biomechanics of vertebral fractures and the vertebral fracture cascade. Curr Osteoporos Rep 8:198–204
Yeni YN, Zinno MJ, Yerramshetty JS, Zauel R, Fyhrie DP (2011) Variability of trabecular microstructure is age-, gender-, race- and anatomic site-dependent and affects stiffness and stress distribution properties of human vertebral cancellous bone. Bone 49:886–894
Duan Y, Seeman E, Turner CH (2001) The biomechanical basis of vertebral body fragility in men and women. J Bone Miner Res Off J Am Soc Bone Miner Res 16:2276–2283
Compston J (2015) Obesity and fractures in postmenopausal women. Curr Opin Rheumatol 27:414–419
Compston JE, Watts NB, Chapurlat R et al (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124:1043–1050
Cauley JA (2017) Osteoporosis: fracture epidemiology update 2016. Curr Opin Rheumatol 29:150–156
Lacombe J, Cairns BJ, Green J, Reeves GK, Beral V, Armstrong ME (2016) The effects of age, adiposity, and physical activity on the risk of seven site-specific fractures in postmenopausal women. J Bone Miner Res Off J Am Soc Bone Miner Res 31:1559–1568
Johansson H, Kanis JA, Oden A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res Off J Am Soc Bone Miner Res 29:223–233
Compston JE, Flahive J, Hosmer DW et al (2014) Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW). J Bone Miner Res Off J Am Soc Bone Miner Res 29:487–493
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 28:88–93
Laslett LL, Just Nee Foley SJ, Quinn SJ, Winzenberg TM, Jones G (2012) Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporos Int J established Result Coop Eur Found Osteoporos Natl Osteoporos Found U S A 23:67–74
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 Off J Am Soc Bone Miner Res 27:294–300
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097
Zeng X, Zhang Y, Kwong JS, Zhang C, Li S, Sun F, Niu Y, Du L (2015) The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: a systematic review. J Evid-Based Med 8:2–10
Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21:1539–1558
Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clin Res Ed) 315:629–634
Roy DK, O'Neill TW, Finn JD et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26
Bredella MA, Lin E, Gerweck AV, Landa MG, Thomas BJ, Torriani M, Bouxsein ML, Miller KK (2012) Determinants of bone microarchitecture and mechanical properties in obese men. J Clin Endocrinol Metab 97:4115–4122
Cohen A, Dempster DW, Recker RR et al (2013) Abdominal fat is associated with lower bone formation and inferior bone quality in healthy premenopausal women: a transiliac bone biopsy study. J Clin Endocrinol Metab 98:2562–2572
Yang S, Nguyen ND, Center JR, Eisman JA, Nguyen TV (2013) Association between abdominal obesity and fracture risk: a prospective study. J Clin Endocrinol Metab 98:2478–2483
Bredella MA, Torriani M, Ghomi RH, Thomas BJ, Brick DJ, Gerweck AV, Harrington LM, Breggia A, Rosen CJ, Miller KK (2011) Determinants of bone mineral density in obese premenopausal women. Bone 48:748–754
Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, Johnson KC, Margolis KL (2006) Risk of fracture in women with type 2 diabetes: the Women's Health Initiative Observational Study. J Clin Endocrinol Metab 91:3404–3410
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
Papaioannou A, Joseph L, Ioannidis G et al (2005) Risk factors associated with incident clinical vertebral and nonvertebral fractures in postmenopausal women: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int J Established Result Coop Eur Found Osteoporos Natl Osteoporos Found U S A 16:568–578
Nevitt MC, Cummings SR, Stone KL et al (2005) Risk factors for a first-incident radiographic vertebral fracture in women > or =65 years of age: the study of osteoporotic fractures. J Bone Miner Res Off J Am Soc Bone Miner Res 20:131–140
Holmberg AH, Johnell O, Nilsson PM, Nilsson J, Berglund G, Akesson K (2006) Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int 17:1065–1077
Yang L, Lv X, Wei D, Yue F, Guo J, Zhang T (2016) Metabolic syndrome and the risk of bone fractures: a meta-analysis of prospective cohort studies. Bone 84:52–56
Nielson CM, Marshall LM, Adams AL, LeBlanc ES, Cawthon PM, Ensrud K, Stefanick ML, Barrett-Connor E, Orwoll ES (2011) BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res Off J Am Soc Bone Miner Res 26:496–502
Villareal DT, Apovian CM, Kushner RF, Klein S (2005) Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society. Obes Res 13:1849–1863
Reid IR (2010) Fat and bone. Arch Biochem Biophys 503:20–27
Cao JJ (2011) Effects of obesity on bone metabolism. J Orthop Surg Res 6:30
Aguirre L, Napoli N, Waters D, Qualls C, Villareal DT, Armamento-Villareal R (2014) Increasing adiposity is associated with higher adipokine levels and lower bone mineral density in obese older adults. J Clin Endocrinol Metab 99:3290–3297
Johansson H, Oden A, Lerner UH et al (2012) High serum adiponectin predicts incident fractures in elderly men: osteoporotic fractures in men (MrOS) Sweden. J Bone Miner Res 27:1390–1396
Bolland MJ, Grey AB, Ames RW, Horne AM, Gamble GD, Reid IR (2006) Fat mass is an important predictor of parathyroid hormone levels in postmenopausal women. Bone 38:317–321
Nickolas TL, McMahon DJ, Shane E (2006) Relationship between moderate to severe kidney disease and hip fracture in the United States. J Am Soc Nephrol 17:3223–3232
Acknowledgements
This research was supported by the National Institute of Health grant K23DK100447.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
None.
Electronic supplementary material
ESM 1
(DOCX 44 kb)
Rights and permissions
About this article
Cite this article
Kaze, A.D., Rosen, H.N. & Paik, J.M. A meta-analysis of the association between body mass index and risk of vertebral fracture. Osteoporos Int 29, 31–39 (2018). https://doi.org/10.1007/s00198-017-4294-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-017-4294-7