Association between fractures and traditional risk factors for osteoporosis and low bone mineral density in patients with obesity

Abstract

Objective: To evaluate the reasons for request of bone mineral density (BMD) evaluation and correlate the BMD results with previous fractures, risk factors for osteoporosis, and clinical characteristics in patients with obesity. Subjects and methods: Cross-sectional, retrospective, single-site study including adult patients with body mass index (BMI) ≥ 30 kg/m 2 and BMD evaluation between January 2015 and May 2016 selected from a BMD database. Data on demographic characteristics, lifestyle habits, comorbidities, medications, risk factors, previous fractures, and indications for BMD evaluation were collected from the participants' medical records. Results: The study included 619 patients (89.9% women, mean BMI 34.79 ± 4.05 kg/m 2). In all, 382 (61.7%), 166 (26.8%), and 71 (11.5%) patients had class 1, 2, and 3 obesity, respectively. The most frequent (29.9%) reason for BMD evaluation was for osteoporosis monitoring. In all, 69.4% of the patients had low BMD. Multivariate analysis showed that age, calcium supplementation, and previous osteoporosis or osteopenia were associated with low BMD, while age, vitamin D supplementation, use of proton pump inhibitors (PPIs), and low BMD were associated with previous fractures (p < 0.05 for all). Conclusions: Among patients with obesity identified from a tertiary hospital database, those with low bone mass and risk factors traditionally associated with fractures had an increased history of fractures. Patients with greater BMI had better bone mass and fewer fractures. These findings indicate that the association between reduced weight, risk factors for osteoporosis, and fractures remained despite the presence of obesity in our population.

The relationship between weight-adjusted-waist index and total bone mineral density in adults aged 20-59

“…BMI and WC are two internationally accepted parameters for identifying obesity, and numerous earlier studies have found positive connections between BMI, WC, and BMD (11, 30). After adjusting for other factors, researchers discovered that BMI was positively linked with lumbar spine BMD in a study involving 2,218 adults between the ages of 40 and 59 (10). In a study involving 2,903 individuals aged 50 and above, researchers found a positive correlation between BMI and WC and femoral neck BMD, with BMI saturation values of 24.3 kg/m 2 (31).…”

“…According to data, obesity incidence in America has climbed from 30.5% in 1999 to 41.9% in 2020, and the yearly medical expenditure associated with obesity is predicted to be at least $173 billion by 2025 (9). Although it was once widely accepted that obesity was positively correlated with either bone density or bone mass (10,11), current research has revealed that the relationship might be the opposite (12,13). Body mass index (BMI) is a typical measurement of obesity, although BMI only assesses overall obesity and ignores how body fat is distributed.…”

Inibidores de bomba de prótons aumenta o risco de fratura óssea em pacientes com comorbidades: uma revisão

“…O trabalho realizado por Sampaio et al (2021), um estudo retrospectivo transversal, buscou a relação entre a baixa densidade mineral óssea (DMO) em pacientes obesos e fraturas e fatores de risco para osteoporose, encontrou também associação de baixa DMO e uso de IBPs em pacientes com fraturas prévias (p<0,05). Embora saiba-se que o aumento do índice de massa corporal (IMC) tem influência positiva na DMO, o estudo abordou em contrapartida que o excesso de peso e gordura visceral podem contribuir para o aumento do risco de fraturas em razão da inflamação e da reabsorção óssea.…”