A Meta‐Analysis of the Association of Fracture Risk and Body Mass Index in Women |
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| Authors: | Helena Johansson John A Kanis Anders Odén Eugene McCloskey Roland D Chapurlat Claus Christiansen Steve R Cummings Adolfo Diez‐Perez John A Eisman Saeko Fujiwara Claus‐C Glüer David Goltzman Didier Hans Kay‐Tee Khaw Marc‐Antoine Krieg Heikki Kröger Andrea Z LaCroix Edith Lau William D Leslie Dan Mellström L Joseph Melton III Terence W O'Neill Julie A Pasco Jerilynn C Prior David M Reid Fernando Rivadeneira Tjerd van Staa Noriko Yoshimura M Carola Zillikens |
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| Affiliation: | 1. WHO Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK;2. Centre for Bone and Arthritis Research (CBAR) at the Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden;3. INSERM UMR 1033, Université de Lyon, H?pital E Herriot, Lyon, France;4. Center for Clinical and Basic Research, Ballerup, Denmark;5. San Francisco Coordinating Center, California Pacific Medical Center Research Institute, University of California, San Francisco, CA, USA;6. Departament de Medicina, Hospital del Mar IMIM‐UAB‐RETICEF, Barcelona, Spain;7. Clinical Translation and Advanced Education, Osteoporosis and Bone Biology, Garvan Institute of Medical Research, St Vincent's Hospital, Sydney, Australia;8. St Vincent's Clinical School, The University of New South Wales, Australia;9. Clinical Excellence and Research, Sydney School of Medicine, Notre Dame University, Sydney, Australia;10. Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan;11. Sektion Biomedizinische Bildgebung, Klinik für Radiologie, Universit?tsklinikum Schleswig‐Holstein, Kiel, Germany;12. Department of Medicine, McGill University, Montreal, Canada;13. Department of Bone & Joint, Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland;14. Department of Public Health and Primary Care, University of Cambridge, UK;15. Department of Musculoskeletal Medicine, CHUV, Lausanne, Switzerland;16. Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland;17. Fred Hutchinson Cancer Research Center, Seattle, USA;18. Hong Kong Orthopaedic and Osteoporosis Center for Treatment and Research, Hong Kong;19. Department of Medicine, University of Manitoba, Winnipeg, Canada;20. Division of Epidemiology, College of Medicine, Mayo Clinic, Rochester, MN, USA;21. Arthritis and Rheumatism Council (ARC), Epidemiology Research Unit, University of Manchester, Manchester, UK;22. Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands;23. School of Medicine, Deakin University, Geelong, Australia;24. Department of Medicine and Endocrinology, University of British Columbia, Vancouver, Canada;25. School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK;26. Department of Internal Medicine, Erasmus MC Rotterdam, The Netherlands;27. Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK;28. Department of Public Health, Wakayama Medical University School of Medicine, Wakayama, Japan |
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| Abstract: | Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20–105) years and follow up of 2.2 million person‐years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m2) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non‐obese women. Compared to a BMI of 25 kg/m2, the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m2 was 0.87 (95% confidence interval [CI], 0.85–0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09–1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored. © 2014 American Society for Bone and Mineral Research. |
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| Keywords: | BMI FRACTURE RISK POPULATION STUDIES POISSON REGRESSION MODEL WOMEN OBESITY |
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