Divergent effects of obesity on fragility fractures

Abstract

Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm) and decreased for others (hip, pelvis, wrist). Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc) are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX® might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals.

The effect of osteoporosis on cochlear function in postmenopausal women: An observational study

“…A significant difference in the results of the hip total T score without any difference in the results of the lumber vertebra total T score can be explained by the presence of degenerative processes such as osteoarthritis affecting the results of the vertebra. In addition, several recent studies have suggested that the widespread belief that obesity is protective against fracture and that obesity is a risk factor for certain fractures [28]. In our study BMI was significantly lower in osteoporotic individuals.…”

Influence of body weight on bone mass, architecture and turnover

“…Also, the precise relationship between weight and fracture rate may depend upon fracture type. Increased weight is generally associated with reduction in osteoporotic fractures (hip and vertebral) but in obese subjects there appears to be an increase in the less common upper arm and ankle fractures (Caffarelli, et al 2014; Compston et al 2011; Mpalaris, et al 2015; Prieto-Alhambra, et al 2012). In general, if weight gain leads to successful skeletal adaptation, as evidenced by an increase in BMD, fracture risk is reduced.…”

The role of leptin in regulating bone metabolism

“…IGF-1) [59]. In the case of high adiposity, which can increase leptin and cortisol, central leptin resistance may mediate the unexpected negative effects of obesity on bone metabolism [62, 63]. Thus, leptin's inhibition of cortisol and glucocorticoids may help to improve bone growth.…”

“…Obesity caused decreased bone mass density in a controlled study of rats [62]. Obesity may also cause increased fracture risk in humans [63]. Although in the past, it was thought that obesity was protective against osteoporosis and bone fracture risk, new evidence may suggest that obesity, implicated with low-grade inflammation and sarcopenia, may not confer benefits on bone mass [63, 89].…”

“…Obesity may also cause increased fracture risk in humans [63]. Although in the past, it was thought that obesity was protective against osteoporosis and bone fracture risk, new evidence may suggest that obesity, implicated with low-grade inflammation and sarcopenia, may not confer benefits on bone mass [63, 89]. This relationship may be altered through the states of leptin or insulin resistance found in obesity and which in turn seem to relate to poorer bone health outcomes [90, 91].…”