How Does Obesity Influence the Risk of Vertebral Fracture? Findings From the UK Biobank Participants

Abstract

Obesity and osteoporotic-related fractures are two common public health problems, although it is unclear how obesity affects the risk of vertebral fractures. The purpose of this study was to examine the association between different measures of obesity and the risk of vertebral fracture, and to establish the various clinical factors that can predict such risk. We analyzed data obtained from 502,543 participants in the UK Biobank (229,138 men and 273,405 women), aged 40 to 69 years. Imaging information was available in a subset of this cohort (5189 participants: 2473 men and 2716 women). We further examined how BMD and geometry of the vertebrae were related to body fat measures. It was shown that a larger waist circumference (WC), but not BMI, was associated with an increase in fracture risk in men, but in women, neither BMI nor WC affected the risk. Trunk fat mass, visceral adipose tissue (VAT) mass, and limb fat mass were negatively associated with vertebral body BMD and geometry in men and women. BMD and geometry are related to vertebral strength, but may not be directly related to the risk of fractures, which is also influenced by other factors. The binary logistic regression equation established in this study may be useful to clinicians for the prediction of vertebral fracture risks, and may provide further information to supplement the fracture risk assessment tool, which assesses general fracture risks.

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

“…Fifty-four studies were also discarded because the full-text was not available. The full-text of the remaining 487 reports was assessed for eligibility: 353 studies were excluded, leaving 134 for inclusion in the systematic review [ 20 – 22 , 25 , 52 – 181 ]. All included studies were in English or French.…”

“…Some studies also reported lower bone turnover in obesity, with a predominance of reduced bone formation over bone resorption [ 23 , 24 ]. Besides, some studies also used obesity criteria other than BMI to assess the association between obesity and bone fragility [ 25 – 27 ]. Furthermore, coexistence of obesity with type 2 diabetes, which has also been associated with an increased risk of fracture [ 19 ], deteriorated bone microarchitecture (e.g., increased cortical porosity) and altered bone turnover [ 19 , 28 ], may further impair bone health in individuals with obesity.…”

Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008–2009 (KNHANES IV)

“…As a result, we can predict that as weight increases, spinal bone density increases, and the fracture rate decreases. Another study showed that high BMI and waist circumference in women were associated with a decrease in bone density due to increase in fat mass; however, whether these factors affect the lumbar spine fracture rate needs further study [ 26 ].…”

Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV)

“…Another study showed that high BMI and waist circumference in women were associated with a decrease in bone density due to increase in fat mass; however, whether these factors affect the lumbar spine fracture rate needs further study. (25) Recently, it was reported that obesity is related to the site of fragility fractures. One study found that obesity led to lower risk of lumbar and femur fractures (17) ; however, another study showed that obesity increased the non-vertebral fracture rate.…”