Severity of Underweight and Risk of Fracture: a Korean Nationwide Population-based Cohort Study

Overview

Journal Sci Rep

Specialty Science

Date 2022 Jun 17

PMID 35710927

Authors

Sangsoo Han

Jiwon Park

Sangun Nah

Hae-Dong Jang

Kyungdo Han

Jae-Young Hong

Affiliations

Soon will be listed here.

Abstract

Underweight is an important modifiable risk factor for fractures. However, there have been few large cohort studies regarding the relationship between underweight and fracture in the general population. We investigated the risk of fracture development according to underweight severity in a large population cohort. This nationwide cohort study included 2,896,320 people aged ≥ 40 years who underwent national health checkups in 2009 and were followed up to identify the incidence of fracture until December 31, 2018. After applying the exclusion criteria that included overweight and obese individuals, the study population was divided according to body mass index (BMI) into normal weight (18.5 ≤ BMI < 23.0), mild underweight (17.5 ≤ BMI < 18.5), moderate underweight (16.5 ≤ BMI < 17.5), and severe underweight (BMI < 16.5) groups. Cox proportional hazards regression analyses were performed to calculate the hazard ratios for risk of fracture according to underweight severity. Severely underweight participants had a 28% increased fracture risk (adjusted hazard ratio [HR] 1.28, 95% confidence interval [CI] 1.20-1.37) compared with those of normal weight. In addition, fracture risk was increased by 14% in individuals with moderate underweight (adjusted HR 1.14, 95% CI 1.08-1.19) and 9% in those with mild underweight (adjusted HR 1.09, 95% CI 1.06-1.13). The severity of underweight was significantly associated with risk of fracture.

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References

Yoo J, Shin D, Han K, Kim D, Yoon J, Lee D . Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea. JAMA Netw Open. 2021; 4(1):e2030405. PMC: 7788464. DOI: 10.1001/jamanetworkopen.2020.30405. View

Muhlberg A, Museyko O, Bousson V, Pottecher P, Laredo J, Engelke K . Three-dimensional Distribution of Muscle and Adipose Tissue of the Thigh at CT: Association with Acute Hip Fracture. Radiology. 2018; 290(2):426-434. DOI: 10.1148/radiol.2018181112. View

Yang S, Nguyen N, Center J, Eisman J, Nguyen T . Association between hypertension and fragility fracture: a longitudinal study. Osteoporos Int. 2013; 25(1):97-103. DOI: 10.1007/s00198-013-2457-8. View

Tanaka S, Kuroda T, Saito M, Shiraki M . Overweight/obesity and underweight are both risk factors for osteoporotic fractures at different sites in Japanese postmenopausal women. Osteoporos Int. 2012; 24(1):69-76. DOI: 10.1007/s00198-012-2209-1. View

Lim J, Park H . Relationship between underweight, bone mineral density and skeletal muscle index in premenopausal Korean women. Int J Clin Pract. 2016; 70(6):462-8. DOI: 10.1111/ijcp.12801. View

Prakash K, Choudhary R, Singh G . Lean Body Mass, Body Fat Percentage, and Handgrip Strength as Predictors of Bone Mineral Density in Postmenopausal Women. J Midlife Health. 2022; 12(4):299-303. PMC: 8849155. DOI: 10.4103/jmh.jmh_21_21. View

Taylor A, Gary L, Arora T, Becker D, Curtis J, Kilgore M . Clinical and demographic factors associated with fractures among older Americans. Osteoporos Int. 2010; 22(4):1263-74. PMC: 3767033. DOI: 10.1007/s00198-010-1300-8. View

Nielson C, Srikanth P, Orwoll E . Obesity and fracture in men and women: an epidemiologic perspective. J Bone Miner Res. 2013; 27(1):1-10. DOI: 10.1002/jbmr.1486. View

Cordero A, Masia M, Galve E . Physical exercise and health. Rev Esp Cardiol (Engl Ed). 2014; 67(9):748-53. DOI: 10.1016/j.rec.2014.04.005. View

10.

Unnanuntana A, Gladnick B, Donnelly E, Lane J . The assessment of fracture risk. J Bone Joint Surg Am. 2010; 92(3):743-53. PMC: 2827823. DOI: 10.2106/JBJS.I.00919. View

11.

Jordan S, Lim L, Berecki-Gisolf J, Bain C, Seubsman S, Sleigh A . Body mass index, physical activity, and fracture among young adults: longitudinal results from the Thai cohort study. J Epidemiol. 2013; 23(6):435-42. PMC: 3834281. DOI: 10.2188/jea.je20120215. View

12.

Tamakoshi A, Yatsuya H, Lin Y, Tamakoshi K, Kondo T, Suzuki S . BMI and all-cause mortality among Japanese older adults: findings from the Japan collaborative cohort study. Obesity (Silver Spring). 2009; 18(2):362-9. DOI: 10.1038/oby.2009.190. View

13.

Yoo J, Shin D, Han K, Kim D, Lee S, Jeong S . Blood Pressure Variability and the Risk of Dementia: A Nationwide Cohort Study. Hypertension. 2020; 75(4):982-990. DOI: 10.1161/HYPERTENSIONAHA.119.14033. View

14.

Seong S, Kim Y, Khang Y, Park J, Kang H, Lee H . Data Resource Profile: The National Health Information Database of the National Health Insurance Service in South Korea. Int J Epidemiol. 2016; 46(3):799-800. PMC: 5837262. DOI: 10.1093/ije/dyw253. View

15.

Gariballa S, Alessa A . Sarcopenia: prevalence and prognostic significance in hospitalized patients. Clin Nutr. 2013; 32(5):772-6. DOI: 10.1016/j.clnu.2013.01.010. View

16.

Sheng M, Lau K, Baylink D . Role of Osteocyte-derived Insulin-Like Growth Factor I in Developmental Growth, Modeling, Remodeling, and Regeneration of the Bone. J Bone Metab. 2014; 21(1):41-54. PMC: 3970294. DOI: 10.11005/jbm.2014.21.1.41. View

17.

Court-Brown C, Duckworth A, Ralston S, McQueen M . The relationship between obesity and fractures. Injury. 2019; 50(8):1423-1428. DOI: 10.1016/j.injury.2019.06.016. View

18.

Kim W, Nam G, Han K, Jung J, Lee J, Park C . Impact of waist circumference on the risk of vertebral fracture: A nationwide cohort study in South Korea. Bone. 2021; 145:115870. DOI: 10.1016/j.bone.2021.115870. View

19.

Perez-Lopez F, Ara I . Fragility fracture risk and skeletal muscle function. Climacteric. 2015; 19(1):37-41. DOI: 10.3109/13697137.2015.1115261. View

20.

Han S, Jang H, Choi S, Kim G, Han K, Lim H . Changes in physical activity and risk of fracture: a Korean nationwide population-based cohort study. Sci Rep. 2020; 10(1):16266. PMC: 7531000. DOI: 10.1038/s41598-020-73495-1. View