Relationship of body mass index with main limb fragility fractures in postmenopausal women

Modulo Dipartimentale di Medicina Interna, Istituti Ortopedici Rizzoli, Via Pupilli,1, 40136, Bologna, Italy.
Journal of Bone and Mineral Metabolism (Impact Factor: 2.46). 04/2009; 27(4):479-84. DOI: 10.1007/s00774-009-0056-8
Source: PubMed


Body mass index (BMI) has been found to be related to the risk of osteoporotic hip fractures in women, regardless of bone mineral density (BMD). The same relationship is under debate for other limb fragility fractures. Very few studies have investigated the comparison of fracture risk among BMI categories, classified according to the WHO criteria, despite the potential usefulness of such information for clinical purposes. To address these issues we studied 2,235 postmenopausal women including those with fragility fractures of the hip (187), ankle (108), wrist (226) and humerus (85). Statistical analyses were performed by logistic regression by treating the fracture status as the dependent variable and age, age at menopause, femoral neck BMD and BMI as covariates. BMI was tested as a continuous or categorical variable. As a continuous variable, increased BMI had a protective effect against hip fracture: OR 0.949 (95% CI, 0.900-0.999), but carried a higher risk of humerus fracture: OR 1.077 (95% CI, 1.017-1.141). Among the BMI categories, only leanness: OR 3.819 (95% CI, 2.035-7.168) and obesity: OR 3.481 (95% CI, 1.815-6.678) showed a significantly higher fracture risk for hip and humerus fractures, respectively. There was no relationship between ankle and wrist fractures and BMI. In conclusion, decreasing BMI increases the risk for hip fracture, whereas increasing BMI increases the risk for humerus fractures. Leanness-related low BMD and obesity-related body instability might explain the different BMI relationships with these two types of fracture.

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    • "The GLOW study, a prospective cohort study involving 723 physician practices in ten countries, has reported that the risk of incident ankle and upper leg fractures was significantly higher in obese than nonobese women, while the risk of wrist fracture was significantly lower.21 A previous Italian study, carried out on 2,235 Italian postmenopausal women with fracture, reported that increased BMI was associated with a significantly higher risk of humerus fracture and a lower risk of hip fracture, whereas no relationship was seen between BMI and either wrist or ankle fractures.37 Using data from the Womens’ Health Initiative (WHI) study in postmenopausal women, Beck et al reported that overweight and obese women presented a higher incidence of lower-extremity and a lower incidence of hip fractures with respect to normal weight women.38 "
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    ABSTRACT: Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm) and decreased for others (hip, pelvis, wrist). Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc) are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX(®) might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals.
    Full-text · Article · Sep 2014 · Clinical Interventions in Aging
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    • "Body weight or BMI has been found to be inversely related to the risk of osteoporotic fracture [3] [7]. BMD appears to be reduced in lean postmenopausal women in most [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18] but not all studies [4, 19–22]; in some studies BMD was reduced [4] [20] [23] [24], whereas in other studies BMD was increased [8– 15, 22]. Thus, the role of obesity as a risk factor for low BMD, osteoporosis, and its related fractures remains unsettled. "
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    ABSTRACT: Objective. Although several studies have investigated the association between body mass index (BMI) and bone mineral density (BMD), the results are inconsistent. The aim of this study was to further investigate the relation between BMI, weight and BMD in an Iranian men population. Methods. A total of 230 men 50-79 years old were examined. All men underwent a standard BMD scans of hip (total hip, femoral neck, trochanter, and femoral shaft) and lumbar vertebrae (L2-L4) using a Dual-Energy X-ray Absorptiometry (DXA) scan and examination of body size. Participants were categorised in two BMI group: normal weight <25.0 kg/m(2) and overweight and obese, BMI ≥ 25 kg/m(2). Results. Compared to men with BMI ≥ 25, the age-adjusted odds ratio of osteopenia was 2.2 (95% CI 0.85, 5.93) and for osteoporosis was 4.4 (1.51, 12.87) for men with BMI < 25. It was noted that BMI and weight was associated with a high BMD, compatible with a diagnosis of osteoporosis. Conclusions. These data indicate that both BMI and weight are associated with BMD of hip and vertebrae and overweight and obesity decreased the risk for osteoporosis. The results of this study highlight the need for osteoporosis prevention strategies in elderly men as well as postmenopausal women.
    Full-text · Article · Oct 2013 · Journal of Osteoporosis
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    • "Recently, some researchers (Gnudi et al., 2009; Morin e/ al., 20091 have found associated increased risk of hip fracture youngerwomen with lower BMI (BMId" 18.5 kg/mJ. On the other hand, higher risk of humerus fractures has been reported in postrnenopausal women with higher BMI (Gnudi et al., 2009). "

    Full-text · Article · Oct 2012
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