Association between abdominal obesity and fracture risk: a prospective study

Association between the appendicular skeletal muscle mass-to-visceral fat area ratio and bone mineral density and osteoporosis: A cross-sectional study

OBJECTIVE

This cross-sectional study investigated the association between appendicular skeletal muscle mass-to-visceral fat area ratio (SVR), bone mineral density (BMD), and osteoporosis in U.S. adults using NHANES data.

METHODS

Data from the 2013-2014 and 2017-2018 NHANES cycles were analyzed. Multivariable regression models assessed associations between SVR, BMD, and osteoporosis, adjusting for demographic, lifestyle, metabolic, and comorbidity variables. Generalized Additive Models with smooth curve fitting and likelihood ratio tests evaluated model fit. Subgroup analyses explored effect modifications.

RESULTS

The study included 2325 individuals with a mean age of 50.66 ± 5.55 years. In fully adjusted models, the highest SVR tertile was associated with a 0.05 g/cm2 higher BMD (β = 0.05, 95 % CI: 0.03-0.08, P = 0.002) and 57 % lower odds of osteoporosis (OR = 0.43, 95 % CI: 0.24-0.78, P = 0.028) than the lowest tertile. As a continuous variable, SVR remained significantly associated with BMD (β = 0.03, 95 % CI: 0.02-0.04, P = 0.002) and osteoporosis (OR = 0.67, 95 % CI: 0.50-0.91, P = 0.033). Stronger associations were found in individuals with diabetes (β = 0.09, 95 % CI: 0.06-0.12, P < 0.01) and BMI ≥ 30 (β = 0.07, 95 % CI: 0.05-0.09, P < 0.01).

CONCLUSION

Higher SVR was significantly associated with increased BMD and lower odds of osteoporosis, suggesting its potential as a marker for bone health assessment. However, the cross-sectional design limits causal inference. Further longitudinal and mechanistic studies are warranted to confirm these findings and explore clinical applicability.

The Associations Between Individual Anthropometric Measurements and Fracture Risk: A Mendelian Randomization Study

BACKGROUND

The primary objective of this study was to investigate and substantiate the possible causal connections between measurements of body dimensions and the likelihood of experiencing fractures.

MATERIALS AND METHODS

We employed a two-sample Mendelian randomization (MR) analysis to examine the associations between anthropometric measurements and two specific traits-bone mineral density and fracture risk. To ensure the credibility of our causal conclusions, we used the inverse variance weighted (IVW) method along with various sensitivity analyses.

RESULTS

Our findings suggest a notable link between increased height and the likelihood of fractures. Specifically, employing the IVW method revealed that for every 10-cm increase in height, there was a 6.0% rise in fracture risk (odds ratio [OR], 1.06; 95% CI, 1.06-1.13; P=.0001). This outcome was further supported by both the weighted-median method and the MR-Egger method, with an OR of 1.10 (95% CI, 1.03-1.16; P=.0003) and an OR of 1.11 (95% CI, 1.08-1.17; P=.0020), respectively. No statistically significant associations were observed between other measurements, such as body mass index (BMI), waist-to-hip ratio adjusted for BMI, hip circumference adjusted for BMI, and waist circumference adjusted for BMI, and fracture risk. Sensitivity analyses, including MR-Egger regression's intercept test and multivariate testing, indicated no substantial presence of directional pleiotropy in instrumental variables, ensuring the stability and reliability of our analysis results.

CONCLUSION

Our study used MR to present genetic evidence supporting height as a distinct causal factor in fracture susceptibility. Our findings underscore the importance of incorporating anthropometric measurements into the development of strategies for preventing and treating osteoporosis. [Orthopedics. 2025;48(1):25-29.].

B7-1 and PlGF-1 are two possible new biomarkers to identify fracture-associated trauma patients at higher risk of developing complications: a cohort study

BACKGROUND

Around 10% of fractures lead to complications. With increasing fracture incidences in recent years, this poses a serious burden on the healthcare system, with increasing costs for treatment. In the present study, we aimed to identify potential 'new' blood markers to predict the development of post-surgical complications in trauma patients following a fracture.

METHODS

A total of 292 trauma patients with a complete three-month follow-up were included in this cohort study. Blood samples were obtained from 244 of these patients. Two complication groups were distinguished based on the Clavien-Dindo (CD) classification: CD grade I and CD grade III groups were compared to the controls (CD 0). The Mann-Whitney U test was used to compare the complication groups to the control group.

RESULTS

Analysis of the patients' data revealed that risk factors are dependent on sex. Both, males and females who developed a CD III complication showed elevated blood levels of B7-1 (p = 0.015 and p = 0.018, respectively) and PlGF-1 (p = 0.009 and p = 0.031, respectively), with B7-1 demonstrating greater sensitivity (B7-1: 0.706 (male) and 0.692 (female), PlGF-1: 0.647 (male) and 0.615 (female)). Further analysis of the questionnaires and medical data revealed the importance of additional risk factors. For males (CD 0: 133; CD I: 12; CD III: 18 patients) alcohol consumption was significantly increased for CD I and CD III compared to control with p = 0.009 and p = 0.007, respectively. For females (CD 0: 107; CD I: 10; CD III: 12 patients) a significantly increased average BMI [kg/m2] from 25.5 to 29.7 with CD III was observed, as well as an elevation from one to three comorbidities (p = 0.003).

CONCLUSIONS

These two potential new blood markers hold promise for predicting complication development in trauma patients. Nevertheless, further studies are necessary to evaluate the diagnostic utility of B7-1 and PlGF-1 in predicting complications in trauma patients and consider sex differences before their possible use as routine clinical screening tools.

Association of obesity with osteoporotic fracture risk in individuals with bone metabolism-related conditions: a cross sectional analysis

Introduction

This study aimed to investigate the individual and composite associations of different indices of obesity on osteoporotic fractures at three different sites among individuals affected by conditions influencing bone metabolism.

Methods

Participants were included from the National Health and Nutrition Examination Survey (NHANES), a national cross-sectional survey. BMI and WC were used separately and in combination to evaluate the presence of obesity. Obesity was defined as BMI ≥ 30 kg/m2, WC ≥ 88 cm in females, and WC ≥ 102 cm in males. Associations between obesity and osteoporotic fractures were assessed using multivariable logistic regression and OR curves. Associations modified by age, sex, race, and alcohol consumption were also evaluated.

Results

A total of 5377 participants were included in this study. In multivariable logistic regression analyses, we found that BMI, WC, BMI defining obesity, and WC defining obesity were negatively associated with hip fracture (all p < 0.05). However, harmful associations between WC and BMI defining obesity and spine fracture were found (all p < 0.05). OR curves revealed that BMI and WC had a linear relationship with hip and spine fractures (all P for non-linearity >0.05). Further analyses showed that the highest WC quartile was harmfully associated with a higher risk of spine fractures (p < 0.05). Obese participants diagnosed by both BMI and WC were less likely to have hip fractures but more likely to have spine fractures (all P for trend <0.05). A significant interaction between age (Ref: age < 50 years) and BMI and WC was detected for hip fractures (all P for interaction <0.05).

Discussion

In people with conditions influencing bone metabolism, obesity diagnosed by BMI and WC was associated with a lower risk of hip fracture, while obesity diagnosed by BMI and the highest WC quartile were associated with a higher risk of spine fracture.

The association of waist circumference with bone mineral density and risk of osteoporosis in US adult: National health and nutrition examination survey

PURPOSE

Obesity and osteoporosis (OP) are receiving increasing attention. Waist circumference (WC) is an effective indicator for assessing central obesity. Currently, there is controversy regarding the relationship between WC and bone mineral density (BMD), as well as OP. Therefore, our study aims to utilize data from the National Health and Nutrition Examination Survey (NHANES) to evaluate the relationship between WC and BMD, as well as OP, in US adults.

METHODS

This cross-sectional study included subjects aged ≥18 years from the NHANES 1999-2018. Multivariate linear regression models were performed to investigate the association between WC and BMD. Multivariate logistic regression models were employed to assess the relationship between WC and OP. Restricted cubic spline curves were used to assess potential nonlinear association between WC and BMD, OP. Subgroup analysis and sensitivity analysis were performed to assess the robustness of the results.

RESULTS

Finally, 11,165 participants (non-OP, n = 10,465; OP, n = 700) were included in the final analysis. The results showed that WC was positively associated with total femur (TF), femoral neck (FN), and lumbar spine (LS) BMD, and might be a protective factor for OP, independent of traditional confounding factors. For each 1 cm increased in WC, TF BMD, FN BMD and LS BMD increased by 0.004 g/cm2, 0.003 g/cm2 and 0.003 g/cm2, respectively, and the risk of OP decreased by 3.1 %. Furthermore, there was a non-linear relationship between WC and BMD, OP. The association remained robust in sensitivity and subgroup analyses.

CONCLUSION

In US adults, there is a positive association between WC and BMD, and WC may be a protective factor for the risk of OP. The association between WC and BMD as well as OP exhibits a non-linear relationship.

Associations of abdominal obesity with different types of bone fractures in adults: A systematic review and dose-response meta-analysis of prospective cohort studies

Findings on the association between abdominal obesity and hip fracture were summarized in a meta-analysis in 2017; however, no study has examined the dose-response association between abdominal fat indices and hip fracture. Also, we found no meta-analysis investigating other types of bone fractures including any vertebral fractures in relation to abdominal obesity. Therefore, the present systematic review and dose-response meta-analysis of prospective cohort studies were conducted to examine the association between abdominal obesity and different types of bone fractures. A comprehensive literature search was done by searching PubMed, Scopus, Web of Science, and Google Scholar until October 2021. In total, 23 articles from prospective cohort studies with a total sample size of 3,456,631 participants were included. During the follow-up periods ranging between 4 and 26 years, 137,989 cases of bone fracture were recorded. After comparing the highest and lowest categories of abdominal fat indices, the summary relative risks (RRs) of any, hip, and vertebral fractures were 0.99 (95% CI: 0.81-1.20), 1.09 (95% CI: 0.82-1.43), and 1.18 (95% CI: 1.05-1.33), respectively, indicating a significant positive association between abdominal obesity and risk of vertebral fracture. In the non-linear dose-response analysis, abdominal obesity based on the waist-to-hip ratio (WHR) was positively associated with an increased risk of hip fracture from 0.7 to 1.1 units of WHR. In the linear analysis, a 10 cm increase in waist circumference (WC) was associated with a 3% higher risk of vertebral fracture. We found no other dose-response association for other types of bone fractures. In conclusion, abdominal obesity may be associated with a higher risk of hip and vertebral fractures.

Early-life famine exposure, adulthood obesity patterns, and risk of low-energy fracture

Malnutrition in early life increases the risk of osteoporosis, but the association of early-life undernutrition combined with adulthood obesity patterns with low-energy fracture remains unknown. This study included 5323 community-dwelling subjects aged ⩾40 years from China. Early-life famine exposure was identified based on the participants' birth dates. General obesity was assessed using the body mass index (BMI), and abdominal obesity was evaluated with the waist-to-hip ratio (WHR). Low-energy fracture was defined as fracture occurring after the age of ⩾40 typically caused by falls from standing height or lower. Compared to the nonexposed group, the group with fetal, childhood, and adolescence famine exposure was associated with an increased risk of fracture in women with odds ratios (ORs) and 95% confidence intervals (CIs) of 3.55 (1.57-8.05), 3.90 (1.57-9.71), and 3.53 (1.05-11.88), respectively, but not in men. Significant interactions were observed between fetal famine exposure and general obesity with fracture among women (P for interaction = 0.0008). Furthermore, compared with the groups with normal BMI and WHR, the group of women who underwent fetal famine exposure and had both general and abdominal obesity had the highest risk of fracture (OR, 95% CI: 3.32, 1.17-9.40). These results indicate that early-life famine exposure interacts with adulthood general obesity and significantly increases the risk of low-energy fracture later in life in women.

Effect of BMI-Discordant Abdominal Tissue Thickness on Fracture Probability: A Registry-Based Study

FRAX, which is used to assess fracture probability, considers body mass index (BMI), but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by dual-energy X-ray absorptiometry (DXA) and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (<-2 cm, -2 to -1 cm) to higher (1-2 cm, >+2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR = 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects before age 65 years (HR = 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes, there was also increased risk for those in the lowest ATI category (HR = 1.73, 95% CI 1.12-2.65 for MOF; 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not found in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Evaluation of the relationship between abdominal fat distribution and osteoporotic vertebral compression fracture with MRI

OBJECTIVE

This study was carried out to investigate the effects of abdominal subcutaneous adiposity and visceral adiposity on osteoporotic compression fractures.

MATERIAL AND METHODS

The study group consisted of a total of 152 individuals aged 50-80 years; 76 were included in the vertebral fracture group and 76 in the healthy control group, whose bone mineral density was calculated. In order to determine the distribution of abdominal fat in both groups, four different measurements, i.e., sagittal abdominal diameter (SAD), abdominal diameter (AD), ventral subcutaneous thickness (VST), and dorsal subcutaneous thickness (DST), were made using lumbar magnetic resonance imaging (MRI). The visceral fat ratio (VFR) was also calculated based on these measurements.

RESULTS

There was a significant difference between the patient and control groups in VST and DST values, both when gender distribution was and was not taken into account (p < 0.006 for all cases). There was no significant difference between the patient and control groups in SAD and AS values, both when only female patients were considered, and gender distribution was not taken into account (p > 0.25 for all cases). On the other hand, in the analysis, when only male patients were considered, the SAD and AD values of the patient group were found to be significantly lower than those of the control group (p = 0.046 and p = 0.048, respectively).

CONCLUSION

In conclusion, the study findings indicated that high SAD values in the male gender and high VST and DST values in both genders were associated with low lumbar vertebral fracture risk.

Association between fat mass by bioelectrical impedance analysis and bone mass by quantitative ultrasound in relation to grip strength and serum 25-hydroxyvitamin D in postmenopausal Japanese women: the Unzen study

Background

Whether fat mass or lean mass affects bone mass in postmenopausal women is controversial. This study aimed to explore the association between body composition measured by bioelectrical impedance analysis (BIA) and bone mass measured by quantitative ultrasound (QUS) in postmenopausal women in Japan.

Methods

We conducted a cross-sectional study, The Unzen Study, on 382 community-dwelling postmenopausal Japanese women (mean (standard deviation) age: 68.2 (7.2) years) who participated in periodic health examinations. The stiffness index (SI) was measured using QUS, and body composition (e.g., fat mass and muscle mass) was measured using BIA. Grip strength was measured. Fasting blood samples were collected, and 25-hydroxyvitamin D (25(OH)D), tartrate-resistant acid phosphatase-5b (TRACP-5b), and parathyroid hormone (PTH) levels were measured. Data on current smoking, alcohol consumption, exercise, and any comorbidities (heart disease, lung disease, stroke, or diabetes mellitus) were collected.

Results

The SI increased with increasing quartiles of fat mass and muscle mass (both p for trend <  0.001), respectively. There were positive correlations between SI and log (25(OH)D) or grip strength. Fat mass significantly correlated with grip strength. Multiple linear regression analysis showed that higher fat mass was independently and significantly associated with higher SI after adjusting for age, height, comorbidity, current smoking, alcohol consumption, exercise, log (25(OH)D), log (TRACP-5b), log (PTH), and grip strength (p = 0.001). In contrast, no association was observed between muscle mass and SI.

Conclusions

Fat mass, but not muscle mass, was a significant determinant of SI in community-dwelling postmenopausal Japanese women.

Obesity and Bone Health: A Complex Relationship

Recent scientific evidence has shown an increased risk of fractures in patients with obesity, especially in those with a higher visceral adipose tissue content. This contradicts the old paradigm that obese patients were more protected than those with normal weight. Specifically, in older subjects in whom there is a redistribution of fat from subcutaneous adipose tissue to visceral adipose tissue and an infiltration of other tissues such as muscle with the consequent sarcopenia, obesity can accentuate the changes characteristic of this age group that predisposes to a greater risk of falls and fractures. Other factors that determine a greater risk in older subjects with obesity are chronic proinflammatory status, altered adipokine secretion, vitamin D deficiency, insulin resistance and reduced mobility. On the other hand, diagnostic tests may be influenced by obesity and its comorbidities as well as by body composition, and risk scales may underestimate the risk of fractures in these patients. Weight loss with physical activity programs and cessation of high-fat diets may reduce the risk. Finally, more research is needed on the efficacy of anti-osteoporotic treatments in obese patients.

Impact of Obesity on Bone Metabolism in Children

Obesity is an epidemic disease that can increase the incidence of type 2 diabetes, cardiovascular disease, malignancy, hypertension, and other health problems that affect the musculoskeletal system. There is a complex interaction between obesity and bone metabolism. In children with obesity, the peroxisome proliferator-activated receptor gamma pathway causes the differentiation of mesenchymal stem cells into adipocytes via osteoblasts, in which results in low bone mass and osteoporosis. Systemic inflammation in obesity has negative effects on bone metabolism. An increase in the number and size of adipose tissue and adipocytokines secreted from adipocytes affect the bone mass of the whole body with hormonal and biochemical effects. The skeletal effects of obesity are mediated by higher oxidative stress and increased production of proinflammatory cytokines. Osteoporosis due to obesity has increased morbidity and mortality in recent years, resulting in important health problems in developed and developing countries.

The Relationship Between Bone Mineral Density and Body Composition Among Qatari Women With High Rate of Obesity: Qatar Biobank Data

Studies have reported inconsistent results for the relationship between body composition and bone mineral density (BMD) among women, especially those with a high rate of obesity. This study aims to examine the association between BMD and body composition among Qatari women. A cross-sectional study, using data from the Qatar Biobank (QBB), was conducted on 2,000 Qatari women aged 18 and over. Measurements were taken by dual-energy X-ray absorptiometry (DEXA) for body composition [visceral fat and android fat (AF)], gynoid fat (GF), trunk fat, total fat mass (TFM), total lean mass (LM) and bone mineral density (BMD), including the lumber spine, neck, femur and total body. The participants were divided into groups of normal and low BMD, based on their T-score. Non-linear regression analysis using the restricted cubic spline method was performed according to the T-score of the total BMD for the fat mass variables. Women with a low BMD (T-score <-1) had significantly lower body composition indicators. LM was positively correlated with BMD at the spine (r = 0.29, p < 0.001), neck (r = 0.32, p < 0.001), and femur (r = 0.28, p < 0.001), as well as total BMD (r = 0.29, p < 0.001) and T-score (r = 0.31, p < 0.001), while the correlatio between TFM and BMD was negative and weak (r = -0.05, <0.017). Results of the non-linear regression indicated that components of fat distribution (TFM, AF, GF and trunk fat) were positively associated with total body T-score. In the adjusted non-liner regression, only a slight increase in T-score was recorded with an increase in FM. The association between FM and BMD was non-linear, suggesting that FM may not be a strong protector of bones among women with high rate of obesity.

The Anthropometric Measure 'A Body Shape Index' May Predict the Risk of Osteoporosis in Middle-Aged and Older Korean People

A body shape index (ABSI) is a recently introduced index of abdominal adiposity, relative to body mass index and height, and represents an alternative to body mass index and waist circumference. We aimed to determine whether ABSI is associated with osteoporosis and the ability of ABSI to predict osteoporosis, to investigate the relationship between obesity and osteoporosis In total, 6717 Korean participants (3151 men and 3566 women; 63.6 ± 8.5 years) were recruited and placed into the Normal, Osteopenia, or Osteoporosis groups on the basis of the minimum T-scores of the lumbar spine, proximal femur, and femoral neck. The T-scores of each region and ABSI were compared among the groups and odds ratios and cut-off values of ABSI for osteoporosis were calculated. In participants of both sexes, ABSI tended to increase as bone health deteriorated. The men and women in the highest quartile of ABSI were 1.887 and 2.808 times more likely to have osteoporosis, respectively, and the potential ABSI cut-off values for osteoporosis were 0.0813 and 0.0874 for male and female participants, respectively. These findings suggest that augmentation of ABSI and obesity is associated with a higher risk of osteoporosis and that ABSI may predict the risk of osteoporosis.

Sarcopenic obesity defined by visceral adiposity was associated with osteoporotic vertebral fracture

BACKGROUND

Previous studies have reported that the fracture risk related to sarcopenic obesity (SO) may be influenced by the distribution of fat mass. Therefore, it is useful to explore a body component suitable for defining obesity when predicting fracture risk. This study was an attempt to explore the contribution of SO defined by visceral adiposity on the incidence of osteoporotic fracture.

METHODS

We enrolled 736 Chinese patients aged > 60 years in this prospective study. Sarcopenia was defined as low skeletal muscle index (SMI) with muscle strength or low SMI with low physical performance. Obesity was categorized as follows: (1) android to gynoid ratio (A/G ratio, men > 0.82, women > 0.65) as an indicator of visceral adiposity; (2) body fat percentage (men > 27.8%; women > 34.5%); and (3) body mass index (≥ 25 kg/m²). A Cox proportional hazard model was used to determine the association between SO and the risk of osteoporotic fracture.

RESULTS

The incidence of SO was 8.7%; 9.0% in females and 8.1% in males. Of 223 (30.2%) patients with self-reported fractures. SO classified by A/G was associated with an increased risk of osteoporotic vertebral fracture (HR: 1.71, 95% CI: 1.07-2.72). High SMI was associated with a reduced risk of osteoporotic vertebral fracture (HR: 0.82, 95% CI: 0.72-0.93), higher BMI was associated with a higher risk vertebral fracture (HR: 1.12, 95% CI: 0.94-1.63), and higher A/G ratio was associated with a higher risk of any fracture (HR: 1.28, 95% CI: 1.14-1.43) and osteoporotic vertebral fracture (HR: 1.19, 95% CI: 1.05-1.36).

CONCLUSIONS

Our findings suggest that SO, defined by visceral adiposity, was associated with the risk of osteoporotic vertebral fracture. Moreover, low SMI, low muscle strength and visceral adiposity were independently associated with osteoporotic fracture.

Bone Microarchitecture in Obese Postmenopausal Chinese Women: The Chinese Vertebral Osteoporosis Study (ChiVOS)

BACKGROUND

Obesity is associated with improved bone mass and microarchitecture in Caucasian individuals, but evidence in obese Asian individuals is lacking.

OBJECTIVE

To analyze the areal bone mineral density (aBMD) and bone microarchitecture in normal-weight, overweight, and obese postmenopausal Chinese women.

METHODS

A total of 243 postmenopausal women from the Chinese Vertebral Osteoporosis Study (ChiVOS) were included and were divided into three groups (OB, obese group; OW, overweight group; NW, normal weight group) by BMI level. aBMD, trabecular bone score (TBS), and appendicular lean mass (ALM) were measured by dual-energy X-ray absorptiometry (DXA). Bone microarchitecture was measured by HR-pQCT at the distal radius and tibia. X-ray was performed to confirm vertebral fractures (VFs). Multiple linear regression was used to evaluate the correlations between bone parameters and ALM after adjusting for confounding variables.

RESULTS

The prevalence of VFs and clinical fractures were similar among the groups. Participants in the OB group showed a lower level of osteocalcin with comparable levels of other bone turnover markers (BTMs). The aBMD at several skeletal sites was higher in the OB group than in the NW group after adjusting for age (p<0.01 for all comparisons). At the radius, the OB group had a higher Ct.Ar, Tb.vBMD, Tb.BV/TV, Tb.N, Tb.Th, and Ct.Th than the NW group after adjusting for covariates (p<0.05 for all). Differences of a similar magnitude were found at the distal tibia. There was a trend of decreasing trend in Tb.Sp, Tb.1/N/SD, and Ct.Po among groups at both sites. However, the bone microarchitecture did not differ between participants with severe obesity (BMI≥35.0kg/m²) and those with 30.0≤BMI<35 kg/m². Multiple linear regression revealed that the associations between ALM and most of the bone microarchitecture parameters at both sites were much stronger than the association between body weight and bone parameters.

CONCLUSION

We have observed significant improvements in aBMD, bone geometry, and bone microarchitecture in obese postmenopausal Chinese women. Except for a lower level of osteocalcin in the OB group, no significant differences in BTMs were found among the groups. Compared with body weight, ALM may explain greater variance in the improvement of bone microarchitecture parameters.

Quantification of lumbar vertebral fat deposition: Correlation with menopausal status, non-alcoholic fatty liver disease and subcutaneous adipose tissue

PURPOSE

To assess abdominal fat deposition and lumbar vertebra with iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL-IQ) and investigate their correlation with menopausal status.

MATERIALS AND METHODS

Two hundred forty women who underwent routine abdominal MRI and IDEAL-IQ between January 2016 and April 2021 were divided into two cohorts (first cohort: 120 pre- or postmenopausal women with severe fatty livers or without fatty livers; second cohort: 120 pre- or postmenopausal women who were obese or normal weight). The fat fraction (FF) values of the liver (FF_liver) and lumbar vertebra (FF_lumbar) in the first group and the FF values of subcutaneous adipose tissue (SAT) (FF_SAT) and FF_lumbar in the second group were measured and compared using IDEAL-IQ.

RESULTS

Two hundred forty women were evaluated. FF_lumbar was significantly higher in both pre- and postmenopausal women with severe fatty liver than in patients without fatty livers (premenopausal women: p < 0.001, postmenopausal women: p < 0.001). No significant difference in the FF_lumbar was observed between obese patients and normal-weight patients among pre- and postmenopausal women (premenopausal women: p = 0.113, postmenopausal women: p = 0.092). Significantly greater lumbar fat deposition was observed in postmenopausal women than in premenopausal women with or without fatty liver and obesity (p < 0.001 for each group). A high correlation was detected between FF_liver and FF_lumbar in women with severe fatty liver (premenopausal women: r=0.76, p<0.01; postmenopausal women: r=0.82, p<0.01).

CONCLUSION

Fat deposition in the vertebral marrow was significantly associated with liver fat deposition in postmenopausal women.

Anthropometric and Body Composition Measurements Related to Osteoporosis in Geriatric Population

Objective:

This study aimed to evaluate different anthropometric and body composition measurements, including weight, body mass index (BMI), body fat percentage (fat%), skeletal muscle index (SMI), a body shape index (ABSI), waist circumference (WC), and hip circumference (HC), in relation to bone mineral density.

Methods:

This is a cross-sectional study of a total of 482 patients who consulted the geriatric outpatient clinic between 2018 and 2019. Patients were evaluated with dual-energy X-ray absorptiometry. Anthropometric measurements (HC, WC, weight, BMI, and ABSI), as well as body composition analysis (fat% and SMI) by bioimpedance analysis system, were performed. The patients were evaluated with the rapid Assessment of Physical Activity Index in terms of aerobic exercise habits.

Results:

There was a significant correlation between lumbar spine (LS) T-score and SMI (r=0.36, p=0.000) and between LS T-score and weight (r=0.21, p=0.000), BMI (r=0.10, p=0.045) and WC (r=0.15, p=0.001). There was a statistically significant correlation between femur neck (FN) T-score and fat% (r=0.15, p=0.001), SMI (r=0.15, p=0.010), weight (r=0.22, p=0.000), BMI (r=0.20, p=0.000), WC (r=0.14, p=0.003), and HC (r=0.17, p=0.001). There was no statistically significant correlation between physical activity and LS T-score (n=353, r=0.08, p=0.16) and FN T-score (n=360, r=0.03, p=0.53). In multiple regression analysis, SMI contributes most in predicting FN and LS T-scores.

Conclusions:

Anthropometric measurements should be carefully selected in the geriatric population. Among the measurements, the strongest relationship was found between LS T-score and SMI.

Mechanoadaptation of the bones of mice with high fat diet induced obesity in response to cyclical loading

An upward trend in childhood obesity implies a great need to determine its effects, both immediate and long-term. Obesity is osteoprotective in adults, but we know very little about the effects of obesity on the growing skeleton, particularly its ability to adapt to load. The objective of this research is to assess bone mechanoadaptation in adolescent obese mice. Ten mice were fed a high-fat diet (HFD) from 4 to 16 weeks of age, while a control group of the same size received a normal diet (ND). At 14 weeks of age, right tibiae were cyclically loaded with a 12 N peak load for HFD mice and a 9 N peak load for ND mice three times a week for two weeks, resulting in equal peak strains of about 2500 microstrain. At 16 weeks of age, mice were sacrificed, and tibiae and gonadal fat pads were dissected. Fat pads were weighed as an obesity indicator, and tibiae were imaged with microCT to measure bone structure. The left tibiae (nonloaded) were subsequently decalcified, stained with osmium, and scanned to quantify marrow fat. Results showed that HFD mice had larger tibial cross-sectional areas compared to ND mice, as well as greater marrow adiposity. However, there was no significant difference in the amount of bone adaptation in the cortical or trabecular bone between the two groups. This indicates that the bones of HFD and ND mice adapt equally well to loading.

Diabetes and Osteoporosis: Part II, Clinical Management

Diabetes-induced osteoporosis is characterized by an increase in fracture risk. FRAX, the most widely used tool, underestimates the risk of fracture in both type 1 and type 2 diabetes. Specific adjustments to FRAX can help to better identify patients with diabetes at increased risk of fracture and select those at high fracture risk for treatment. Although clinical trial data are limited, the available evidence indicates that the presence of diabetes does not alter antiosteoporotic treatment response in patients with diabetes.

Impact of waist circumference on the risk of vertebral fracture: A nationwide cohort study in South Korea

Evidence on the association between abdominal obesity and vertebral fracture (VF) risk is limited. We examined the association of waist circumference (WC) and abdominal obesity with VF risk in 352,095 South Korean participants aged ≥40 years who underwent health checkups between 2009 and 2012. Abdominal obesity was defined by WC ≥90 cm in men and ≥ 85 cm in women according to the Asian-specific WC cutoff for abdominal obesity. Participants were a representative sample cohort of the Korean National Health Insurance System. The hazard ratios (HRs) and 95% CIs of VF development were determined using multivariable Cox proportional hazard regression analysis. During the 5.5 years of follow-up, there were 2030 and 4968 new cases of VF in men and women, respectively. In men, those with abdominal obesity showed an elevated HR (1.11, 95% CI: 1.01-1.23) of incident VF than did those without abdominal obesity. In women, the HRs of VF increased in higher WC groups after adjusting for confounders (P for trend <0.001); the HR decreased in those with WC <75.0 cm (HR: 0.81, 95% CI: 0.75-0.88) and increased in those with WC 85.0-89.9 cm (HR: 1.12, 95% CI: 1.02-1.22), 90.0-94.9 cm (HR: 1.19, 95% CI: 1.08-1.32), and ≥ 95.0 cm (HR: 1.27, 95% CI: 1.12-1.43) compared with those with WC 80.0-84.9 cm. This association persisted after stratification by age in women. WC and abdominal obesity were positively associated with VF risk in women, and abdominal obesity was associated with VF risk even in men. The consideration of WC and controlling abdominal obesity may be helpful in reducing future VF risk.

General and central obesity operate differently as predictors of falls requiring medical care in older women: a population-based cohort study in Spain

OBJECTIVES

to examine the association of general and abdominal obesity with falls, falls requiring medical care and falls with fractures in older women.

DESIGN

a population-based prospective cohort of 1,185 women aged ≥60 in Spain, followed up from 2008 to 2010 through 2012.

MEASURES

weight, height and waist circumference were measured at baseline using standardised techniques. Participants were classified according to body mass index as normal weight (<25), overweight (25-29.9) and general obesity (≥30). Abdominal obesity was defined as waist circumference >88 cm. In 2012, participants reported the falls experienced in the previous year. Logistic regression models were mutually adjusted for general and abdominal obesity and for main confounders.

RESULTS

in this cohort of older women, a total of 336 women experienced falls, 168 of them had falls requiring medical care and 64 falls with fractures. For falls, no association was found with general obesity nor abdominal obesity. However, compared with normal weight, overweight women had a decreased risk for falls requiring medical care [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.94] and for falls with fractures (OR 0.27; 95% CI 0.12-0.63). The corresponding values for general obesity were 0.44 (0.24-0.81) and 0.30 (0.11-0.82). Abdominal obesity was positively associated with falls requiring medical care (OR 1.82; 95% CI 1.12-2.94) and falls with fractures (OR 2.75; 95% CI 1.18-6.44).

CONCLUSIONS

in older women, general obesity may protect from falls requiring medical care and falls with fractures. On the contrary, abdominal obesity increased the risk of suffering from types of falls.

Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration

The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).

Effects of metabolic syndrome on bone health in older adults: the Bushehr Elderly Health (BEH) program

Based on the clinical, BMD, and TBS data of 2380 participants aged ≥ 60 which was gathered during the BEH program, stage II, we showed that MetS was positively associated with BMD, while a negative or no association was observed between MetS and TBS depending on the sex and the adjustment model.

INTRODUCTION

The results of previous reports in regard to the effect of metabolic syndrome (MetS) on bone health are not conclusive. This study aimed to evaluate the association between MetS with bone mineral density (BMD) and trabecular bone score (TBS) as an indicator of bone quantity and quality, respectively.

METHODS

Using a cross-sectional design, this study was carried out based on the data collected during the BEH Program, stage II. MetS was defined according to NCEP-ATP III criteria. BMD (at the lumbar spine and the hip) and lumbar spine TBS were assessed by dual-energy X-ray absorptiometry device.

RESULTS

The data of 2380 participants (women = 1228, men = 1152) aged ≥ 60 were analyzed. In the fully adjusted regression models (including BMI), significant associations between MetS and mean BMD were observed across all locations in men (P values ≤ 0.001) and in the lumbar spine in women (P value = 0.003). In addition, the prevalence of osteoporosis (based on BMD) was significantly lower in those with MetS than those without MetS in both sexes, even after full adjustments (women, OR = 0.707, P value = 0.013; men, OR = 0.563, P value = 0.001). In contrast, in age-adjusted regression analyses, the prevalence of degraded bone microarchitecture (TBS ≤ 1.2) was significantly increased in those with MetS than those without, irrespective of the participants' sex (P values < 0.05). The mean TBS was also negatively associated with MetS in women (β = - 0.075, P value = 0.007) but not in men (β = - 0.052, P value = 0.077), in age-adjusted regression models. However, after including BMI in the adjusted models, all significant associations between TBS values and MetS disappeared.

CONCLUSION

It seems that a positive association exists between MetS and BMD, while MetS is either not associated or negatively correlated with bone quality as measured by TBS.

Association between abdominal obesity and fragility fractures among elderly Israeli women

BACKGROUND

Obesity has been traditionally viewed as a protective factor for fractures. Recent studies have challenged this concept, particularly regarding abdominal obesity. We aimed to investigate the association between abdominal obesity, body mass index (BMI) and fragility fractures prevalence in a sample of community-dwelling elderly Israeli women.

METHODS

The data in this cross-sectional study were based on 'Mabat Zahav'-a survey of a nationally representative sample of elderly Israelis. The study population included 669 women. Data on fragility fractures site and circumstances were self-reported, and height, weight, waist and calf circumferences were measured. Waist circumference (WC) variable was divided into tertiles: < 88 cm, 88-99 cm and > 99 cm.

RESULTS

Sixty-five women reported fragility fractures (14 hip fractures, 18 vertebral fractures and 39 wrist fractures). Mean age was 73.9 ± 5.9 years, mean BMI was 29.9 ± 5 kg/m² and mean WC was 93.9 ± 12 cm. While BMI was not associated with osteoporotic fractures, abdominal obesity (WC > 88 cm) was positively associated with fragility fractures, independently of age, smoking, physical activity [middle and high WC tertiles {3.15 (95% CI 1.41-7.02), 2.78 (95% CI 1.05-7.31), respectively}].

CONCLUSIONS

Among this sample of elderly women, abdominal obesity was positively associated with fragility fractures, independently of age, smoking, physical activity and BMI. Waist circumference, an easily measured anthropometric indicator, may be useful for assessing the risk of fragility fractures in elderly women, particularly among those with normal or high BMI-a vast population which has been traditionally considered as having lower fracture risk.

Contribution of Android and Gynoid Adiposity to Bone Mineral Density in Healthy Postmenopausal Thai Women

Dual-energy X-ray absorptiometry (DXA) is one of the major tools for assessing the whole body and regional body composition and body adiposity. Various body composition parameters including android fat mass (AFM), gynoid fat mass (GFM), and android-to-gynoid fat ratio (AG fat ratio) obtained from whole body DXA can be used as a reliable surrogate marker for regional body composition analysis. This study aimed to explore the contribution of android and gynoid adiposity to bone mineral density (BMD) in healthy postmenopausal Thai women. This cross-sectional study enrolled 1448 healthy Thai women, ages 40-90 without medication history or known disease affecting the BMD. Lumbar spine (LS), total femur, and femoral neck BMDs, AFM, GFM, and AG fat ratio were measured by DXA. To evaluate the contribution of android and gynoid adiposity with various measures of BMDs, univariable and multivariable linear regression analyses were used to estimate the regression coefficients. AFM, GFM, and AG fat ratio had a significant positive association with BMD of all measured sites (p < 0.001) in the univariate analysis. The strongest association was found between AG fat ratio and LS BMD (β = 0.156, p ≤ 0.001). In multivariate linear regression analysis, the results continued to show a positive association between AFM and GFM at all skeletal sites after adjusting for age, height, and total body lean mass. Relationship between AG fat ratio and BMD was found only in LS region. GFM had a strongest positive effect with BMD at the LS, total femur, and femoral neck regions. Higher android and gynoid adiposity was associated with higher BMD. GFM rather than AFM shows the strongest positive association with BMDs in postmenopausal Thai women.

The association of reduced bone density with paraspinal muscle atrophy and adipose tissue in geriatric patients: a cross-sectional CT study

Background/aim

The aim of the study is to examine the relationship among bone density, adipose tissue, and muscle mass with abdominal CT in geriatric patients.

Materials and methods

The study is a retrospective cohort study of patients 65 years and over who underwent abdominal CT for any reason between October 2017 and July 2018. Third lumbar vertebra density, fatty degeneration of the paraspinal muscle, subcutaneous adipose tissue, and mesenteric adipose tissue ratio were evaluated.

Results

A total of 312 patients, 144 females and 168 males, were included in the study. Reduced bone density was found in 237 (76%) patients. Reduced bone density and muscle atrophy was more frequent in females (P < 0.001). Muscle atrophy was found to occur 5.7 times more frequently in cases of reduced bone density (OR, 95% CI = 5.74 (3.27–10.09), P < 0.001). There was no significant relationship found between reduced bone density and subcutaneous adipose tissue thickness or mesenteric adipose tissue ratio (P = 0.073, P = 0.939, respectively).

Conclusion

In the geriatric age group, reduced bone density and muscle atrophy were quite common and were significantly more frequent in women. Furthermore, a strong association between reduced bone density and muscle atrophy was found. No relationship was found between reduced bone density and subcutaneous adipose tissue thickness–mesenteric adipose ratio.

Interaction of Nutrition and Exercise on Bone and Muscle

Physical activity and nutritional factors, such as calcium and vitamin D intake, have been shown in numerous studies to be beneficial to musculoskeletal health at different points in the lifecourse. However, the evidence that physical activity and nutrition may act synergistically for benefit is far more sparce; the best data come from studies that consider calcium, vitamin D or creatine supplementation in combination with physical activity interventions to promote better musculoskeletal health. Some observational data also suggest that a 'healthier' lifestyle, characterised by a more 'prudent' diet and higher reported levels of physical activity is also associated with better musculoskeletal health in late adulthood. Given the public health burden of osteoporosis and sarcopenia in our aging population, well designed randomised controlled trials are now timely and much needed.

Is elevated body mass index protective against cervical spine injury in adults?

PURPOSE

Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma.

MATERIALS AND METHODS

Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period.

RESULTS

A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18-25) patients, 6.2% for overweight/obese (BMI 25-35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18-25 as a reference group, females with BMI > 25-35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41-0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26-0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12-4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46-0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups.

CONCLUSION

An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.

A meta-analysis of the association between body mass index and risk of vertebral fracture

We conducted a meta-analysis of prospective studies to assess the association between BMI and incident vertebral fracture. We found that as body mass index (BMI) increases, the risk of vertebral fracture decreases in men, but not in women, suggesting possible gender differences in the relationship of BMI with risk of vertebral fracture.

INTRODUCTION

Recent evidence suggests that the relationship between BMI and fracture risk may be site-specific. We conducted a systematic review and meta-analysis of prospective studies to investigate the association between BMI and risk of incident vertebral fracture.

METHODS

PubMed and Embase were searched for relevant articles published from inception through February 15, 2017. Extracted relative risks (RR) from the prospective studies were pooled using random-effects meta-analysis.

RESULTS

Six studies were included, with a total of 105,129 participants followed for 3 to 19 years. The pooled RR (95% confidence interval [CI]) for vertebral fracture per each standard deviation increase in BMI was 0.94 (95% CI = 0.80-1.10) with significant heterogeneity (I ² = 88.0%, p < 0.001). In subgroup analysis by gender, we found a significant inverse association between BMI and risk of vertebral fracture in men (RR = 0.85, 95% CI = 0.73-0.98, n = 25,617 participants) but not in women (RR = 0.98, 95% CI = 0.81-1.20, n = 79,512 participants). Across studies of women not adjusting for bone mineral density (BMD), there was no significant association between BMI and risk of vertebral fracture (RR = 0.91, 95% CI = 0.80-1.04, p = 0.18, n = 72,755 participants). However, BMI was associated with an increased risk of vertebral fracture in studies of women that adjusted for BMD (RR = 1.28, 95% CI = 1.17-1.40, p < 0.001, n = 6757 participants). Substantial heterogeneity was found among studies of women (I ² = 90.1%, p < 0.001), which was partly explained by the adjustment for BMD (adjusted R ² = 61%). We found no evidence of publication bias (p = 0.40).

CONCLUSIONS

In conclusion, our findings suggest that there might be gender differences in the relationship of BMI with risk of vertebral fracture. Further research is needed, including the assessment of other measures of adiposity, such as visceral adiposity, on the risk of vertebral fracture.

Relationship between obesity, sarcopenia, sarcopenic obesity, and bone mineral density in elderly subjects aged 80 years and over

Objective

This study sought to analyze the relationship between the components and aggravations of body composition (obesity, sarcopenia, and sarcopenic obesity) and bone mineral density in elderly subjects aged ≥80 years.

Methods

A cross-sectional study design was utilized to assess 128 subjects aged between 80 and 95 years. Body composition and bone mineral density were measured by dual energy X-ray absorptiometry. Gait speed was assessment by walking test. The statistical analyses included Spearman's correlation, one-way analysis of variance, the chi-squared test, and binary logistic regression analysis.

Results

The elderly subjects with sarcopenia had lower bone mineral density compared to the obesity group, with higher risk for presence of osteopenia/osteoporosis in the spine (OR: 2.81; CI: 1.11-7.11) and femur (OR: 2.75; CI: 1.02-7.44). Obesity was shown to be a protective factor for osteopenia/osteoporosis in the spine (OR: 0.43; CI: 0.20-0.93) and femur (OR: 0.27; CI: 0.12-0.62).

Conclusion

It was found that lean mass is more directly related to bone mineral density (total, femur, and spine) and sarcopenia is associated with osteopenia/osteoporosis. Obesity represents a possible protective factor for osteopenia/osteoporosis in elderly subjects aged 80 years and over.

Abdominal Obesity and Risk of Hip Fracture: A Systematic Review and Meta-Analysis of Prospective Studies

Data on the association between general obesity and hip fracture were summarized in a 2013 meta-analysis; however, to our knowledge, no study has examined the association between abdominal obesity and the risk of hip fracture. The present systematic review and meta-analysis of prospective studies was undertaken to summarize the association between abdominal obesity and the risk of hip fracture. We searched online databases for relevant publications up to February 2017, using relevant keywords. In total, 14 studies were included in the systematic review and 9 studies, with a total sample size of 295,674 individuals (129,964 men and 165,703 women), were included in the meta-analysis. Participants were apparently healthy and aged ≥40 y. We found that abdominal obesity (defined by various waist-hip ratios) was positively associated with the risk of hip fracture (combined RR: 1.24, 95% CI: 1.05, 1.46, P = 0.01). Combining 8 effect sizes from 6 studies, we noted a marginally significant positive association between abdominal obesity (defined by various waist circumferences) and the risk of hip fracture (combined RR: 1.36; 95% CI: 0.97, 1.89, P = 0.07). This association became significant in a fixed-effects model (combined effect size: 1.40, 95% CI: 1.25, 1.58, P < 0.001). Based on 5 effect sizes, we found that a 0.1-U increase in the waist-hip ratio was associated with a 16% increase in the risk of hip fracture (combined RR: 1.16, 95% CI: 1.04, 1.29, P = 0.007), whereas a 10-cm increase in waist circumference was not significantly associated with a higher risk of hip fracture (combined RR: 1.13, 95% CI: 0.94, 1.36, P = 0.19). This association became significant, however, when we applied a fixed-effects model (combined effect size: 1.21, 95% CI: 1.15, 1.27, P < 0.001). We found that abdominal obesity was associated with a higher risk of hip fracture in 295,674 individuals. Further studies are needed to test whether there are associations between abdominal obesity and fractures at other bone sites.

Association between body composition and hip fractures in older women with physical frailty

AIM

We sought to determine the extent to which higher lean and fat mass as measured by dual X-ray absorptiometry in older adults with frailty are related to total hip bone mass density (BMD) index and the rate of hip fractures.

METHODS

The data are from the Women's Health Initiative Observational Study. We identified 872 participants aged ≥65 years with body composition measures and positive frailty. Frailty was determined using modified Fried's criteria. Linear and Cox regressions were used to model study outcomes.

RESULTS

During the follow-up period, 5.6% patients (n = 49) had sustained a hip fracture. Body composition indexes were associated with total hip BMD (P < 0.001 for all). In models adjusted for age, ethnicity, smoking, history of fractures, recurrent falls, number of frailty criteria and corresponding lean mass, the hazard ratio for hip fracture per 1 kg/m2 increase in fat mass was 0.73 (95% confidence interval 0.60-0.88) for appendicular compartment, 0.76 (95% confidence interval 0.65-0.89) for trunk and 0.84 (95% confidence interval 0.77-0.93) for whole-body fat mass. The hazard ratio for hip fracture per 1 kg/m2 increase in appendicular lean mass was 0.63 (95% confidence interval 0.46-0.88). However, after final adjustment for total hip BMD, the only index that remained statistically significant was whole-body fat mass (P for trend = 0.04).

CONCLUSIONS

We showed that in frail older women, higher fat and lean mass was associated with reduced hip-fracture rates. Higher whole-body adiposity, however, was also associated with lower hip-fracture rate independent of total hip BMD. The present results confirm the importance of weight maintenance in frail populations. Geriatr Gerontol Int 2017; 17: 898-904.

Diabetes and Bone Disease

The World Health Organization estimates that diabetes mellitus occurs in more than 415 million people; this number could double by the year 2040. Epidemiologic data have shown that the skeletal system may be a target of diabetes-mediated damage, leading to the development of diabetes-induced osteoporosis. T1D and T2D have been associated with an increased risk of fracture. Bone mineral density and fracture risk prediction tools developed for the general population capture some of the risk associated with diabetes. Recent adaptations to these tools have improved their efficacy in patients with diabetes.

Muscle mass is associated with incident fracture in postmenopausal women: The OFELY study

The relationships between body composition and bone mineral density are well established but the contribution of body composition to the risk of fracture (Fx) has rarely been evaluated prospectively. We analyzed the risk of Fx by body composition in 595 postmenopausal women (mean age 66±8years) from a longitudinal cohort study (Os des Femmes de Lyon). We assessed the risk of the first incident fragility Fx according to body composition obtained from whole-body DXA: abdominal visceral (VFAT) and subcutaneous fat mass (SFAT), total body fat mass (FM), lean mass index (LMI) and appendicular skeletal muscle mass index (ASMI). During a median [IQ] follow-up of 13.1years [1.9], 138 women sustained a first incident Fx, including 85 women with a major osteoporotic Fx (MOP Fx: hip, clinical spine, humerus or wrist). After adjustment for age, women who sustained Fx had lower BMI (-4%, p=0.01), LMI (-6%, p=0.002) and ASMI (-3%, p=0.003), compared with women without Fx. After adjustment for age, prevalent Fx, physical activity, incident falls and FN BMD, each SD increase of baseline values of LMI and ASMI was associated with decreased Fx risk with adjusted hazard ratios of 0.76 for both of p≤0.02. Those associations were similar after accounting for the competing risk of death. VFAT and SFAT were associated with Fx risk in the multivariate model only for MOP Fx and the association did not persist after consideration of competing mortality. We conclude that lean mass and appendicular muscle mass indexes are associated with the risk of fracture in postmenopausal women independently of BMD and clinical risk factors.

Increasing Level of Leisure Physical Activity Could Reduce the Risk of Hip Fracture in Older Women: A Dose-Response Meta-analysis of Prospective Cohort Studies

We carried out the study to investigate and quantitatively assess the potential association between current level of physical activity and the risk of osteoporosis hip fracture in older women. Relevant publications before October 2015 were identified using the PubMed and Ovid searching tools. A dose-response meta-analysis was carried out to combine and analysis results. Fourteen prospective studies were included in the meta-analysis. A general analysis of 9 studies showed a significant inverse relationship between increasing level of physical activity and risk of hip fracture in older women [relative risk (RR) = 0.93, 95% confidence interval (95% CI): 0.91-0.96]. The result of a sensitivity analysis was consistent with the general analysis (RR = 0.94, 95% CI: 0.93-0.96). The association between increasing level of physical activity and risk of wrist fracture was not statistically significant in a general analysis of three studies (RR = 1.004, 95% CI: 0.98-1.03). A potential direct association between increasing level of physical activity and risk of wrist fracture was observed after removing 1 study with the greatest weight (RR = 1.01, 95% CI: 1.00-1.03). No significant publication bias was observed in our analysis. Our results show that increasing level of physical activity within an appropriate range may reduce the risk of hip fracture but not the risk of wrist fracture in older women.

The obesity of bone

During the last decades, obesity and osteoporosis have become important global health problems, and the belief that obesity is protective against osteoporosis has recently come into question. In fact, some recent epidemiologic and clinical studies have shown that a high level of fat mass might be a risk factor for osteoporosis and fragility fractures. Several potential mechanisms have been proposed to explain the complex relationship between adipose tissue and bone. Indeed, adipose tissue secretes various molecules, named adipokines, which are thought to have effects on metabolic, skeletal and cardiovascular systems. Moreover, fat tissue is one of the major sources of aromatase, an enzyme that synthesizes estrogens from androgen precursors, hormones that play a pivotal role in the maintenance of skeletal homeostasis, protecting against osteoporosis. Moreover, bone cells express several specific hormone receptors and recent observations have shown that bone-derived factors, such as osteocalcin and osteopontin, affect body weight control and glucose homeostasis. Thus, the skeleton is considered an endocrine target organ and an endocrine organ itself, likely influencing other organs as well. Finally, adipocytes and osteoblasts originate from a common progenitor, a pluripotential mesenchymal stem cell, which has an equal propensity for differentiation into adipocytes or osteoblasts (or other lines) under the influence of several cell-derived transcription factors. This review will highlight recent insights into the relationship between fat and bone, evaluating both potential positive and negative influences between adipose and bone tissue. It will also focus on the hypothesis that osteoporosis might be considered the obesity of bone.

Positive Association Between Adipose Tissue and Bone Stiffness

Obesity is often considered to have a protective effect against osteoporosis. On the other hand, several recent studies suggest that adipose tissue may have detrimental effects on bone quality. We therefore aimed to investigate the associations between body mass index (BMI), waist circumference (WC), visceral adipose tissue (VAT) or abdominal subcutaneous adipose tissue (SAT), and bone stiffness. The study involved 2685 German adults aged 20-79 years, who participated in either the second follow-up of the population-based Study of Health in Pomerania (SHIP-2) or the baseline examination of the SHIP-Trend cohort. VAT and abdominal SAT were quantified by magnetic resonance imaging. Bone stiffness was assessed by quantitative ultrasound (QUS) at the heel (Achilles InSight, GE Healthcare). The individual risk for osteoporotic fractures was determined based on the QUS-derived stiffness index and classified in low, medium, and high risk. Linear regression models, adjusted for sex, age, physical activity, smoking status, risky alcohol consumption, diabetes, and height (in models with VAT or abdominal SAT as exposure), revealed positive associations between BMI, WC, VAT or abdominal SAT, and the QUS variables broadband-ultrasound attenuation or stiffness index. Moreover, BMI was positively associated with speed of sound. Our study shows that all anthropometric measures including BMI and, WC as well as abdominal fat volume are positively associated with bone stiffness in the general population. As potential predictors of bone stiffness, VAT and abdominal SAT are not superior to easily available measures like BMI or WC.

Association and relative importance of multiple obesity measures with bone mineral density: the National Health and Nutrition Examination Survey 2005-2006

All obesity measures were positively associated with femoral neck bone mineral density (BMD), but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD.

PURPOSE

Multiple measures are used to quantify obesity; different obesity measures have diverse relationship with BMD. Which obesity measure has the most important value in relation to BMD is still poorly understood. We examined the association between multiple obesity measures and BMD and determined the relative importance (RI, percentage of variation) of multiple obesity measures associated with BMD.

METHODS

Data from 5287 men and women aged between 8 and 69 years (mean age = 29 years) in the National Health and Nutrition Examination Survey 2005-2006 were analyzed. Body mass index (BMI), waist circumference, hip circumference, body fat mass (FM) index, total body FM, abdominal FM, and appendicular FM were considered the exposures and femoral neck and lumbar spine BMD the outcomes.

RESULTS

In the multivariable analysis, greater BMI and hip circumference were associated with increased BMD at the lumbar spine and femoral neck (all P < 0.001). The remaining obesity variables were positively associated with increased femoral neck BMD only (all P < 0.001). RI of all obesity measures associated with femoral neck BMD was much greater than that associated with lumbar spine BMD. Moreover, hip circumference had higher RI (19.8 for femoral neck BMD; 7.0 for lumbar spine BMD) than other obesity measures (all RIs ≤14.1 for femoral neck BMD; all RIs ≤3.5 for lumbar spine BMD) in relation to BMD.

CONCLUSIONS

All obesity measures were positively associated with femoral neck BMD, but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD.

Association between fat mass, lean mass, and bone loss: the Dubbo Osteoporosis Epidemiology Study

Lower body fat mass is a risk factor for bone loss at lumbar spine in postmenopausal women, but not in men. Body lean mass and fat mass were not associated with femoral neck bone loss in either gender.

INTRODUCTION

Bone density and body mass are closely associated. Whole body lean mass (LM) and fat mass (FM) together account for approximately 95 % of body mass. Bone loss is associated with loss of body mass but which of the components of body mass (FM or LM) is related to bone loss is not well understood. Therefore, in this study, we sought to assess whether baseline FM or LM has predictive value for future relative rate of bone mineral density (BMD) changes (%/year).

METHODS

The present population-based cohort study was part of the ongoing Dubbo Osteoporosis Epidemiology Study (DOES). BMD, FM, and LM were measured with dual energy X-ray absorptiometry (GE-LUNAR Corp, Madison, WI). BMD measurements were taken in approximately every 2 years between 2000 and 2010. We only included the participants with at least two BMD measurements at the femoral neck and lumbar spine. In total, 717 individuals (204 men and 513 women) aged 50 years or older were studied.

RESULTS

Rate of bone loss at femoral neck and lumbar spine was faster in women than in men (all P < 0.01). In bivariable regression analysis, each 5 kg greater FM in women was associated with 0.4 %/year (P = 0.003) lower bone loss at lumbar spine. This magnitude of association remained virtually unchanged after adjusting for LM and/or other covariates (P = 0.03). After adjusting for covariates, variation of FM accounted for ∼1.5 % total variation in lumbar spine bone loss. However, there was no significant association between FM and change in femoral neck BMD in either men or women.

CONCLUSION

Lower FM was an independent but modest risk factor for greater bone loss at the lumbar spine in women but not in men. If further studies confirm our findings, FM can help predict lumbar spine bone loss in women.

Complex association between body weight and fracture risk in postmenopausal women

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.

Abdominal obesity increases the risk of hip fracture. A population-based study of 43,000 women and men aged 60-79 years followed for 8 years. Cohort of Norway

BACKGROUND

The question as to whether abdominal obesity has an adverse effect on hip fracture remains unanswered. The purpose of this study was to investigate the associations of waist circumference, hip circumference, waist-hip ratio, and body mass index with incident hip fracture.

METHODS

The data in this prospective study is based on Cohort of Norway, a population-based cohort established during 1994-2003. Altogether 19,918 women and 23,061 men aged 60-79 years were followed for a median of 8.1 years. Height, weight, waist and hip circumference were measured at baseline using standard procedures. Information on covariates was collected by questionnaires. Hip fractures (n = 1,498 in women, n = 889 in men) were identified from electronic discharge registers from all general hospitals in Norway between 1994 and 2008.

RESULTS

The risk of hip fracture decreased with increasing body mass index, plateauing in obese men. However, higher waist circumference and higher waist-hip ratio were associated with an increased risk of hip fracture after adjustment for body mass index and other potential confounders. Women in the highest tertile of waist circumference had an 86% (95% CI: 51-129%) higher risk of hip fracture compared to the lowest, with a corresponding increased risk in men of 100% (95% CI 53-161%). Lower body mass index combined with abdominal obesity increased the risk of hip fracture considerably, particularly in men.

CONCLUSION

Abdominal obesity was associated with an increased risk of hip fracture when body mass index was taken into account. In view of the increasing prevalence of obesity and the number of older people suffering osteoporotic fractures in Western societies, our findings have important clinical and public health implications.

Anterior hypopituitarism in adult survivors of childhood cancers treated with cranial radiotherapy: a report from the St Jude Lifetime Cohort study

PURPOSE

To estimate the prevalence of and risk factors for growth hormone deficiency (GHD), luteinizing hormone/follicle-stimulating hormone deficiencies (LH/FSHD), thyroid-stimulatin hormone deficiency (TSHD), and adrenocorticotropic hormone deficiency (ACTHD) after cranial radiotherapy (CRT) in childhood cancer survivors (CCS) and assess the impact of untreated deficiencies.

PATIENTS AND METHODS

Retrospective study in an established cohort of CCS with 748 participants treated with CRT (394 men; mean age, 34.2 years [range, 19.4 to 59.6 years] observed for a mean of 27.3 years [range, 10.8 to 47.7 years]). Multivariable logistic regression was used to study associations between demographic and treatment-related risk factors and pituitary deficiencies, as well as associations between untreated deficiencies and cardiovascular health, bone mineral density (BMD), and physical fitness.

RESULTS

The estimated point prevalence was 46.5% for GHD, 10.8% for LH/FSHD, 7.5% for TSHD, and 4% for ACTHD, and the cumulative incidence increased with follow-up. GHD and LH/FSHD were not treated in 99.7% and 78.5% of affected individuals, respectively. Male sex and obesity were significantly associated with LH/FSHD; white race was significant associated with LH/FSHD and TSHD. Compared with CRT doses less than 22 Gy, doses of 22 to 29.9 Gy were significantly associated with GHD; doses ≥ 22 Gy were associated with LH/FSHD; and doses ≥ 30 Gy were associated with TSHD and ACTHD. Untreated GHD was significantly associated with decreased muscle mass and exercise tolerance; untreated LH/FSHD was associated with hypertension, dyslipidemia, low BMD, and slow walking; and both deficits, independently, were associated with with abdominal obesity, low energy expenditure, and muscle weakness.

CONCLUSION

Anterior pituitary deficits are common after CRT. Continued development over time is noted for GHD and LH/FSHD with possible associations between nontreatment of these conditions and poor health outcomes.

Obesity in older persons

PURPOSE OF REVIEW

There is an increasing number of reports suggesting that indicators of obesity for the general adult population may need to be modified; that the magnitude of risk is attenuated or that adiposity may even be protective; and that additional adverse outcomes specific to older persons need to be considered. Finally, there are benefits and adverse effects of weight loss programmes for older persons. This article reviews publications addressing these issues from 2013 to March 2014.

RECENT FINDINGS

BMI was not considered to be as good an indicator of obesity because of loss of muscle mass with age. Higher body weight seems to be protective among older persons with chronic diseases or geriatric syndromes. Increased adiposity together with decreased muscle mass (sarcopenic obesity) is associated with adverse outcomes, although there is no consensus regarding the definition. Intentional weight loss has health benefits but is accompanied by muscle and bone loss, and therefore programmes should include components to counteract these changes.

SUMMARY

The magnitude of health risk associated with obesity is attenuated with age, and mild increase in adiposity may be beneficial for those who are frail and/or with chronic diseases. Weight loss programmes should include resistance exercises to counteract muscle loss.

Current and future burden of incident hip fractures in New South Wales, Australia

Population ageing presents significant challenges for many developed nations. Accurately forecasting the likely future burden of age-related medical conditions, such as hip fracture, is critical. In this study, we present estimates of the current and future burden of hip fracture in NSW, Australia, providing crucial information for future health care planning.

PURPOSE

The aims of this study were to investigate the burden of hip fracture in Australia's largest state, New South Wales (NSW), and to build a prediction model to forecast the likely future burden of hip fracture from 2016 to 2036 in persons aged 50 years or more.

METHODS

A retrospective population-based cohort study was conducted using NSW hospitalisation data. Standardised incident hip fracture rates and hip fracture-related acute care length of stay and costs were estimated. Predictive negative binomial regression modelling using age, gender and local health district and year covariates together with projected NSW populations was applied to forecast future hip fractures.

RESULTS

Total incident hip fractures increased 8.8 % over a 12-year period from 2000/2001 to 2011/2012 despite declining age-standardised rates. Estimates of acute care length of stay for the treatment of hip fracture ranged from 10 to 15 days and acute care costs ranged between 21 and 29,000 Australian dollars per fracture. By 2036, incident hip fractures are projected to rise by 35.2 %, assuming a continued decline in the rate of hip fracture or by 107.5 % if the current decline in the rate does not continue. Acute care length of stay and costs are each predicted to rise between 37.1 and 110.4 % by 2036.

CONCLUSION

An ageing population and changing demographics will continue to drive the increasing burden of incident hip fractures in NSW and Australia in the foreseeable future. These anticipated changes provide important information for the planning and management of future hip fracture care.

The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes

BACKGROUND

Rotator cuff tear (RCT) has a multifactorial etiology. We hypothesized that obesity may increase the risk of RCT and influence tear size.

MATERIALS AND METHODS

A case-control design study was used. We studied 381 consecutive patients (180 men, 201 women; mean age ± standard deviation, 65.5 ± 8.52 years; range, 43-78 years) who underwent arthroscopic rotator cuff repair. Tear size was determined intraoperatively. The control group included 220 subjects (103 men, 117 women; mean age ± standard deviation, 65.16 ± 7.24 years; range, 42-77 years) with no RCT. Body weight, height, and bicipital, tricipital, subscapularis, and suprailiac skinfolds of all participants were measured to obtain body mass index (BMI) and the percentage of body fat (%BF). For the purposes of the study, the 601 participants were divided into 2 groups by BMI (group A, BMI ≥ 25; group B, BMI < 25). The odds ratios (ORs) were calculated to investigate whether adiposity affects the risk of RCT. Data were stratified according to gender and age. Multiple linear regression analyses were applied to explore the association between obesity and tear size.

RESULTS

The highest ORs for both men (OR, 2.49; 95% confidence interval, 1.41-3.90; P = .0037) and women (OR, 2.31; 95% confidence interval, 1.38-3.62; P = .0071) were for individuals with a BMI ≥ 30; 69% (N = 303) of group A and 48% (N = 78) of group B had RCTs. Patients with RCT had a BMI higher than that of subjects with no RCT in both groups (P = .031, group A; P = .02, group B). BMI and %BF significantly increased from patients with a small tear (BMI, 27.85; %BF, 37.63) to those with a massive RCT (BMI, 29.93; %BF, 39.43). Significant differences were found (P = .004; P = .031).

CONCLUSIONS

Our results provide evidence that obesity, measured through BMI and %BF, is a significant risk factor for the occurrence and severity of RCT.