Complex association between body weight and fracture risk in postmenopausal women

Abstract

Osteoporosis is a common disease, characterized by low bone mass with micro-architectural disruption and skeletal fragility, resulting in an increased risk of fracture. A substantial number of studies has examined the possible relationship between body weight, bone mineral density and fracture risk in post-menopausal women, with the majority of them concluding that low body weight correlates with increased risk of fracture, especially hip fracture. Controversies about the potential protective effect of obesity on osteoporosis and consequent fracture risk still exist. Several recent studies question the concept that obesity exerts a protective effect against fractures, suggesting that it stands as a risk factor for fractures at specific skeletal sites, such as upper arm. The association between body weight and fracture risk is complex, differs across skeletal sites and body mass index, and is modified by the interaction between body weight and bone mineral density. Some potential explanations that link obesity with increased fracture risk may be the pattern of falls and impaired mobility in obese individuals, comorbidities, such as asthma, diabetes and early menopause, as well as, increased parathyroid hormone and reduced 25-hydroxy-vitamin D concentrations.

Ten-year estimated risk of bone fracture in women with differentiated thyroid cancer under TSH-suppressive levo-thyroxine therapy

“…It can therefore be hypothesised that the absence of significant deterioration in bone metabolism may be the result of a protective effect against bone mass loss and that this effect is due to the very state of being overweight or to the slowing down of the metabolism [18]. Moreover, our data show that BMD is not influenced by other factors of bone compromission, except for weight and menopausal status.…”

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

“…Obesity per se is increasingly recognized as a state of heightened fracture risk in both men and women [7,8]. For instance, a study involving over 60,000 women from 10 countries revealed an association between BMI ≥ 30 kg/m 2 and increased risk of ankle and upper leg fractures (with reduced risk of wrist fractures) [7], and a similar correlation was also found in men, albeit only after correction for the increased BMD generally associated with obesity [8], and not without controversy [13]. Interestingly, these fracture sites [7] differ from the fracture sites most commonly seen in osteoporosis, which are the wrist, upper arm, rib, hip and spine [7].…”

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

“…30 kg/m 2 and increased risk of ankle and upper leg fractures (with reduced risk of wrist fractures), (10) and a similar correlation was also found in men, albeit only after correction for the increased BMD generally associated with obesity, (11) and not without controversy. (12) Whether or not obesity per se has an effect on fracture risk, emerging evidence suggests that obesity treatment, namely bariatric surgery-which induces weight losses of up to 75% of excess body weight that are maintained for up to 10 to 14 years postsurgery (13) -results in bone loss. (14,15) However dietinduced weight loss, not bariatric surgery, with or without concomitant physical activity, is seen as the first treatment option for overweight and obesity.…”