Association of Bone Fracture with 30-year Body Mass Index (BMI) Trajectories: Findings from the Framingham Heart Study : Bone Fracture and 30-year BMI Trajectories

Overview

Journal Osteoporos Int

Specialties Endocrinology
Orthopedics

Date 2024 Apr 8

PMID 38587675

Authors

Zihao Xin

Hanfei Xu

Xiaoyu Zhang

Elizabeth J Samelson

Douglas P Kiel

Ching-Ti Liu

Affiliations

Soon will be listed here.

Abstract

Purpose: Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood.

Methods: This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35-64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression.

Results: The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see "Methods" for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13-4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern.

Conclusions: This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life.

References

Cummings S, Melton L . Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002; 359(9319):1761-7. DOI: 10.1016/S0140-6736(02)08657-9. View

Gonnelli S, Caffarelli C, Nuti R . Obesity and fracture risk. Clin Cases Miner Bone Metab. 2014; 11(1):9-14. PMC: 4064448. DOI: 10.11138/ccmbm/2014.11.1.009. View

Kim J, Lee S, Kim S, Lee J, Kim J, Jung J . Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV). BMC Womens Health. 2021; 21(1):60. PMC: 7871625. DOI: 10.1186/s12905-021-01209-4. View

Lespessailles E . [Obesity and osteoporosis]. Rev Prat. 2021; 71(1):91-94. View

Liu Y, Liu C, Guo D, Wang N, Zhao Y, Li D . Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction. J Orthop Surg Res. 2021; 16(1):182. PMC: 7944895. DOI: 10.1186/s13018-021-02336-2. View

Nhan D, Leet A, Lee R . Associations of childhood overweight and obesity with upper-extremity fracture characteristics. Medicine (Baltimore). 2021; 100(18):e25302. PMC: 8104144. DOI: 10.1097/MD.0000000000025302. View

Owattanapanich N, Schellenberg M, Switzer E, Clark D, Matsushima K, Inaba K . Association of Body Mass Index on Injuries and Outcomes After Ground-Level Falls. Am Surg. 2021; 87(10):1584-1588. DOI: 10.1177/00031348211024640. View

Sampaio L, Marques J, Petterle R, Moreira C, Borba V . Association between fractures and traditional risk factors for osteoporosis and low bone mineral density in patients with obesity. Arch Endocrinol Metab. 2021; 65(2):152-163. PMC: 10065326. DOI: 10.20945/2359-3997000000331. View

Sherk V, Heveran C, Foright R, Johnson G, Presby D, Ferguson V . Sex differences in the effect of diet, obesity, and exercise on bone quality and fracture toughness. Bone. 2021; 145:115840. PMC: 11313485. DOI: 10.1016/j.bone.2021.115840. View

10.

Turcotte A, OConnor S, Morin S, Gibbs J, Willie B, Jean S . Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis. PLoS One. 2021; 16(6):e0252487. PMC: 8186797. DOI: 10.1371/journal.pone.0252487. View

11.

Zhang Z, Zhou X, Shu L, Hu M, Gao R, Zhou X . The association between overweight/obesity and vertebral fractures in older adults: a meta-analysis of observational studies. Osteoporos Int. 2021; 32(6):1079-1091. DOI: 10.1007/s00198-020-05764-8. View

12.

Liu C, Broe K, Zhou Y, Boyd S, Cupples L, Hannan M . Visceral Adipose Tissue Is Associated With Bone Microarchitecture in the Framingham Osteoporosis Study. J Bone Miner Res. 2016; 32(1):143-150. PMC: 5316419. DOI: 10.1002/jbmr.2931. View

13.

Liu C, Sahni S, Xu H, McLean R, Broe K, Hannan M . Long-Term and Recent Weight Change Are Associated With Reduced Peripheral Bone Density, Deficits in Bone Microarchitecture, and Decreased Bone Strength: The Framingham Osteoporosis Study. J Bone Miner Res. 2018; 33(10):1851-1858. PMC: 6368222. DOI: 10.1002/jbmr.3472. View

14.

Nielson C, Marshall L, Adams A, LeBlanc E, Cawthon P, Ensrud K . BMI and fracture risk in older men: the osteoporotic fractures in men study (MrOS). J Bone Miner Res. 2010; 26(3):496-502. PMC: 3179296. DOI: 10.1002/jbmr.235. View

15.

De Laet C, Kanis J, Oden A, Johanson H, Johnell O, Delmas P . Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005; 16(11):1330-8. DOI: 10.1007/s00198-005-1863-y. View

16.

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

17.

Chan M, Frost S, Center J, Eisman J, Nguyen T . Relationship between body mass index and fracture risk is mediated by bone mineral density. J Bone Miner Res. 2014; 29(11):2327-35. DOI: 10.1002/jbmr.2288. View

18.

Johansson H, Kanis J, Oden A, McCloskey E, Chapurlat R, Christiansen C . A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res. 2013; 29(1):223-33. DOI: 10.1002/jbmr.2017. View

19.

Shen J, Leslie W, Nielson C, Majumdar S, Morin S, Orwoll E . Associations of Body Mass Index With Incident Fractures and Hip Structural Parameters in a Large Canadian Cohort. J Clin Endocrinol Metab. 2015; 101(2):476-84. PMC: 5393587. DOI: 10.1210/jc.2015-3123. View

20.

Xu H, Cupples L, Stokes A, Liu C . Association of Obesity With Mortality Over 24 Years of Weight History: Findings From the Framingham Heart Study. JAMA Netw Open. 2019; 1(7):e184587. PMC: 6324399. DOI: 10.1001/jamanetworkopen.2018.4587. View