Could obesity be considered as risk factor for non-vertebral low-impact fractures?

Abstract

Background: It has long been established that obesity plays a positive role against osteoporosis (OP) and lowimpact fractures (Fx). However, more recent data has shown higher fracture risk in obese individuals. The aim of this study was to investigate the association between BMI, particularly obesity, OP and low-impact Fx in Brazilian women, as well as to evaluate the SAPORI (Sao Paulo Osteoporosis Risk Index) tool performance to identify low BMD according BMI category. Methods: A total of 6182 women aged over 40 years were included in this cross-sectional analysis using data from two large Brazilian studies. All participants performed hip and spine bone mineral density (BMD) measurements and answered a detailed questionnaire about the presence of clinical risk factors (CRFs) related to low BMD and risk fractures. The World Health Organization (WHO) criteria were used to define obesity. Results: Age-adjusted osteoporosis prevalence was 20.8, 33.6, 47 and 67.1% in obese, overweight, normal and underweight category, respectively. Obesity was present in 29,6% (1.830 women) in the study population and the likelihood of osteoporosis and low-impact Fx compared to a normal BMI in this subgroup was of 0.24 (95% CI 0.20-0.28; p < 0.001) and of 1.68 (95% CI 1.35-2.11; p < 0.001), respectively. However, the hip Fx likelihood was lower in obese compared with non-obese women (OR = 0.44; 95% CI 0.20-0.97). Using an originally validated cutoff , the SAPORI tool sensitivity was significantly hampered in overweight and obese women although the accuracy had remained suitable because of increasing in specificity. Conclusions: The osteoporosis prevalence reduced as BMI increased and obesity was associated with low-impact Fx, regardless of the BMD measurements. Moreover, the SAPORI performance was impaired in obese women.

Bone Mass Effects of Cross-Sex Hormone Therapy in Transgender People: Updated Systematic Review and Meta-Analysis

“…Nevertheless, obesity seems to affect bone health through different mechanisms, such as changes in bone-regulating hormones such as leptin and adiponectin [40], increased oxidative stress, and compromised bone quality, possibly leading to structural bone damage and increased risk of fracture [41, 42]. In addition, the influence of high BMI on fracture risk varies according to skeletal site and is partially independent from BMD [41, 43].…”

Bone Density and Structure in Overweight Men With and Without Diabetes

“…The mechanisms of the increased fracture risk in patients with T1D and T2D are not fully elucidated. Metabolic syndrome (MetS), which consists of obesity, abdominal adiposity, increased blood pressure, impaired glucose tolerance, and dyslipidemia (3), is an important risk factor for T2D, and is associated with an increased risk of fracture in some studies, whereas other studies show neutral or even beneficial effects of obesity (4)(5)(6). Several factors may influence fracture risk in MetS and an observational study reported a strong association between MetS and increased fracture risk in individuals with increasing number of MetS characteristics (7).…”

Relationships between Obesity and Incidence of Fractures in a Middle‐Aged Population: A Study from the CARTaGENE Cohort

“…These findings are in line with a study that found a similar prevalence of nonvertebral low-trauma fractures in women with versus without obesity aged 40 years and older from São Paolo, Brazil, regardless of BMD and other clinical risk factors. (44) This is in contrast to the widespread belief in a protective effect of obesity in fractures. Our results, however, need to be interpreted with caution given the small number of hip fractures in our cohort.…”