Abstract
Summary
This cohort study of 1,614 postmenopausal Japanese women followed for 6.7 years showed that overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized.
Introduction
The effect of body mass index (BMI) on fracture at a given level of bone mineral density (BMD) is controversial, since varying associations between BMI and fracture sites have been reported.
Methods
A total of 1,614 postmenopausal Japanese women were followed for 6.7 years in a hospital-based cohort study. Endpoints included incident vertebral, femoral neck, and long-bone fractures. Rate ratios were estimated by Poisson regression models adjusted for age, diabetes mellitus, BMD, prior fracture, back pain, and treatment by estrogen.
Results
Over a mean follow-up period of 6.7 years, a total of 254 clinical and 335 morphometric vertebral fractures, 48 femoral neck fractures, and 159 long-bone fractures were observed. Incidence rates of vertebral fracture in underweight and normal weight women were significantly lower than overweight or obese women by 0.45 (95 % confidence interval: 0.32 to 0.63) and 0.61 (0.50 to 0.74), respectively, if BMD and other risk factors were adjusted, and by 0.66 (0.48 to 0.90) and 0.70 (0.58 to 0.84) if only BMD was not adjusted. Incidence rates of femoral neck and long-bone fractures in the underweight group were higher than the overweight/obese group by 2.15 (0.73 to 6.34) and 1.51 (0.82 to 2.77) and were similar between normal weight and overweight/obesity.
Conclusions
Overweight/obesity and underweight are both risk factors for fractures at different sites. Fracture risk assessment may be improved if fracture sites are taken into account and BMI is categorized.
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Abbreviations
- BAP:
-
Bone alkaline phosphatase
- BMD:
-
Bone mineral density
- BMI:
-
Body mass index
- CART:
-
Cocaine and amphetamine-regulated transcript
- eGFR:
-
Estimated glomerular filtration rate
- DXA:
-
Dual energy x-ray absorptiometry
- DM:
-
Diabetes mellitus
- FRAX:
-
Fracture risk assessment tool
- FRISC:
-
Fracture and immobilization score
- NTX:
-
N-terminal telopeptide of type I collagen
- SBP:
-
Systolic blood pressure
- SD:
-
Standard deviation
- SERM:
-
Selective estrogen receptor modulator
- ucOC:
-
Undercarboxylated osteocalcin
- VD3:
-
Active vitamin D3
- 25(OH)D:
-
25-Hydroxy-cholecalciferol
- VK2:
-
Vitamin K2
- YAM:
-
Young adult mean
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Acknowledgments
S.T. performed statistical analysis and drafted the manuscript. M. Shiraki is the principal investigator of the Nagano cohort study. S.T., T.K., M. Saito, and M. Shiraki contributed to the interpretation of the data and the writing of the manuscript. This work was partly supported by a grant-in-aid from the Japan Osteoporosis Foundation.
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Tanaka, S., Kuroda, T., Saito, M. et al. Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int 24, 69–76 (2013). https://doi.org/10.1007/s00198-012-2209-1
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DOI: https://doi.org/10.1007/s00198-012-2209-1