Abstract
Summary
The association between obesity and fracture was skeletal site-specific with no gender difference. Obesity was associated with a higher risk of proximal humerus fractures but not for wrist or clinical vertebral fractures.
Purpose
The association between body mass index (BMI) and the risk of clinical fractures at different sites is unclear. This study aimed to examine associations between BMI and fractures at different sites in Korean men and women.
Methods
This study analyzed 285,643 Korean adults (aged 50–80 years) who participated in health examinations from 2002 to 2003 and were followed up until 2015. The incidences of osteoporotic fractures were assessed using the International Classification of Diseases (10th revision; ICD-10) and procedure or radiographic codes. After adjusting for confounders, hazard ratios (HRs) were calculated using Cox proportional hazard models for fracture risk.
Results
Site-specific associations between BMI and fractures were found without gender difference. Specifically, an L-shaped association was found for clinical vertebral fractures, wherein the adjusted HRs per 5 kg/m2 increase were 0.80 (95% confidence interval [CI] = 0.76–0.83) in BMI groups < 25 kg/m2 and 0.97 (95% CI = 0.92–1.03) in BMI ≥ 25 kg/m2. A linear inverse correlation for wrist fractures was observed, wherein the HRs were 0.83 (95% CI = 0.81–0.86) per 5 kg/m2 increase. For proximal humerus fractures, a non-linear U-shape association was found, wherein the adjusted HRs per 5 kg/m2 increase were 0.66 (95% CI = 0.50–0.88) in BMI groups < 23 kg/m2 and 1.25 (95% CI = 1.08–1.45) in BMI ≥ 23 kg/m2.
Conclusion
Low BMI was a risk factor for all tested fractures. Obesity was a risk factor for proximal humerus fracture, but it is a protective factor for wrist fracture.
Similar content being viewed by others
Data availability
The data are available from the Korean National Health Insurance Service (NHIS), but access to confidential data is limited to researchers who meet the necessary criteria. Basically, any researchers who propose a study subject and plans using the standardized proposal form that is approved by the NHIS review committee of research support can access the raw data. The detailed process and a provision guide are now available at http://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do.
References
De Laet C, Kanis JA, Odén A et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338. https://doi.org/10.1007/s00198-005-1863-y
Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573. https://doi.org/10.1002/jbmr.5650080507
Premaor MO, Pilbrow L, Tonkin C, Parker RA, Compston J (2010) Obesity and fractures in postmenopausal women. J Bone Miner Res 25:292–297. https://doi.org/10.1359/jbmr.091004
Nielson CM, Marshall LM, Adams AL et al (2011) BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res 26:496–502. https://doi.org/10.1002/jbmr.235
Compston JE, Watts NB, Chapurlat R et al (2011) Obesity is not protective against fracture in postmenopausal women: GLOW. Am J Med 124:1043–1050. https://doi.org/10.1016/j.amjmed.2011.06.013
Prieto-Alhambra D, Premaor MO, Avilés FF et al (2012) The association between fracture and obesity is site-dependent: a population-based study in postmenopausal women. J Bone Miner Res 27:294–300. https://doi.org/10.1002/jbmr.1466
Johansson H, Kanis JA, Odén A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233. https://doi.org/10.1002/jbmr.2017
Kim SH, Yi SW, Yi JJ, Kim YM, Won YJ (2018) Association between body mass index and the risk of hip fracture by sex and age: a prospective cohort study. J Bone Miner Res 33:1603–1611. https://doi.org/10.1002/jbmr.3464
Yi SW, Ohrr H, Shin SA, Yi JJ (2015) Sex-age specific association of body mass index with all-cause mortality among 12.8 million Korean adults: a prospective cohort study. Int J Epidemiol 44:1696–1705. https://doi.org/10.1093/ije/dyv138
Seong SC, Kim YY, Park SK et al (2017) Cohort profile: the national health insurance service-national health screening cohort (NHIS-HEALS) in Korea. BMJ Open 7:e016640. https://doi.org/10.1136/bmjopen-2017-016640
Lee EY, Lee Y, Yi SW, Shin SA, Yi JJ (2017) BMI and all-cause mortality in normoglycemia, impaired fasting glucose, newly diagnosed diabetes, and prevalent diabetes: a cohort study. Diabetes Care 40:1026–1033. https://doi.org/10.2337/dc16-1458
Yi SW, Jung M, Kimm H, Sull JW, Lee E, Lee KO, Ohrr H (2016) Usual alcohol consumption and suicide mortality among the Korean elderly in rural communities: Kangwha cohort study. J Epidemiol Comm Health 7:778–783. https://doi.org/10.1136/jech-2015-206849
Min WK, Kim DK, Kim DJ et al (2003) Annual report on external quality assessment in clinical chemistry in Korea (2002). J Lab Med Qual Assur 25:1–14
World Health Organization (2010) International statistical classification of disease and related health problems 10th revision. World Health Organization. https://apps.who.int/iris/handle/10665/42980
WHO Expert Consultation (2004) Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 363:157–163. https://doi.org/10.1016/S0140-6736(03)15268-3
Deeks JJ, Altman DG, Bradburn MJ (2001) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Smith GD, Altman DG (eds) Systematic reviews in health care. BMJ Publishing Group, London, pp 285–312. https://doi.org/10.1002/9780470693926.ch15
Laslett LL, Just nee FoleyQuinnWinzenbergJones SJSJTMG (2012) Excess body fat is associated with higher risk of vertebral deformities in older women but not in men: a cross-sectional study. Osteoporos Int 23:67–74. https://doi.org/10.1007/s00198-011-1741-8
Turcotte AF, O’Connor S, Morin SN, Gibbs JC, Willie BM, Jean S, Gagnon C (2021) Association between obesity and risk of fracture, bone mineral density and bone quality in adults: a systematic review and meta-analysis. PLoS ONE 16:e0252487. https://doi.org/10.1371/journal.pone.0252487
Compston JE, Flahive J, Hosmer DW et al (2014) Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the global longitudinal study of osteoporosis in women (GLOW). J Bone Miner Res 29:487–493. https://doi.org/10.1002/jbmr.2051
Gnudi S, Sitta E, Lisi L (2009) Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Metab 27:479–484. https://doi.org/10.1007/s00774-009-0056-8
Andersen S, Frederiksen KD, Hansen S, Brixen K, Gram J, Stoving RK (2014) Bone structure and estimated bone strength in obese patients evaluated by high-resolution peripheral quantitative computed tomography. Calcif Tissue Int 95:19–28. https://doi.org/10.1007/s00223-014-9857-4
Sornay-Rendu E, Boutroy S, Vilayphiou N, Claustrat B, Chapurlat RD (2013) In obese postmenopausal women, bone microarchitecture and strength are not commensurate to greater body weight: the Os des Femmes de Lyon (OFELY) study. J Bone Miner Res 28:1679–1687. https://doi.org/10.1002/jbmr.1880
Evans AL, Paggiosi MA, Eastell R, Walsh JS (2015) Bone density, microstructure and strength in obese and normal weight men and women in younger and older adulthood. J Bone Miner Res 30:920–928. https://doi.org/10.1002/jbmr.2407
Himes CL, Reynolds SL (2012) Effect of obesity on falls, injury, and disability. J Am Geriatr Soc 60:124–129. https://doi.org/10.1111/j.1532-5415.2011.03767.x
Mitchell RJ, Lord SR, Harvey LA, Close JCT (2014) Associations between obesity and overweight and fall risk, health status and quality of life in older people. Aust NZ J Publ Health 38:13–18. https://doi.org/10.1111/1753-6405.12152
Hutcheon JA, Chiolero A, Hanley JA (2010) Random measurement error and regression dilution bias. BMJ 340:c2289. https://doi.org/10.1136/bmj.c2289
Acknowledgements
The authors thank the Big Data Steering Department staff at the National Health Insurance Service (NHIS) for providing the data and support. This study used NHIS-NSC data (NHIS-2021-2-073) prepared by the NHIS.
Author information
Authors and Affiliations
Contributions
Study design: SW Yi and SH Kim. Data analysis: SW Yi. Data interpretation: SW Yi, JH Bae, YM Kim, YJ Won, and SH Kim. Drafting manuscript: SH Kim. All authors contributed to critical revision of the manuscript and approved the final submitted version of the manuscript. SW Yi and SH Kim take responsibility for the integrity of the data analysis.
Corresponding author
Ethics declarations
Conflict of Interest
None.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Yi, SW., Bae, J.H., Kim, Y.M. et al. Relationship between body mass index and fracture risk at different skeletal sites: a nationwide cohort study. Arch Osteoporos 17, 99 (2022). https://doi.org/10.1007/s11657-022-01147-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s11657-022-01147-0