A meta-analysis of the association of fracture risk and body mass index in women
Abstract
Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored.
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The seemingly unaffected BMD observed in our patient sample may still render the patients at an increased risk of fractures.
“Hence, the seemingly unaffected BMD observed in our patient sample may still render the patients at an increased risk of fractures, but the association between BMI and fracture risk is complex (28), and fracture risk was beyond what could be assessed from the current data.”
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- Authors
- Johansson, H., Kanis, J. A., Odén, A., McCloskey, E., Chapurlat, R. D., Christiansen, C., Cummings, S. R., Diez-Perez, A., Eisman, J. A., Fujiwara, S., Glüer, C.-C., Goltzman, D., Hans, D., Khaw, K.-T., Krieg, M.-A., Kröger, H., LaCroix, A. Z., Lau, E., Leslie, W. D., Mellström, D., Melton, L. J., O'Neill, T. W., Pasco, J. A., Prior, J. C., Reid, D. M., Rivadeneira, F., van Staa, T., Yoshimura, N., & Zillikens, M. C.
- Affiliations
- University of Gothenburg (SE)
- WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldUK
- University of Sheffield (GB)
- Inserm (FR)
- Center for Clinical & Basic Research (DK)
- University of California, San Francisco (US)
- Departament de Medicina, Hospital del Mar IMIM-UAB-RETICEFBarcelonaSpain
- Garvan Institute of Medical Research (AU)
- Hiroshima Atomic Bomb Casualty Council (JP)
- University Hospital Schleswig-Holstein (DE)
- McGill University (CA)
- Centre Hospitalier Universitaire Vaudois (CH)
- University of Cambridge (GB)
- Kuopio University Hospital (FI)
- Fred Hutch Cancer Center (US)
- Hong Kong Orthopaedic and Osteoporosis Center for Treatment and ResearchHong Kong
- University of Manitoba (CA)
- Mayo Clinic (US)
- Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands
- Deakin University (AU)
- University of British Columbia (CA)
- University of Aberdeen (GB)
- Erasmus MC (NL)
- Clinical Practice Research DatalinkMedicines and Healthcare Products Regulatory AgencyLondonUK
- Wakayama Medical University (JP)
- Corresponding author
- Johansson, Helena
- ORCID
- Johansson, Helena
- McCloskey, Eugene
- Chapurlat, Roland D
- Christiansen, Claus
- Eisman, John A
- Fujiwara, Saeko
- Glüer, Claus-C
- Goltzman, David
- Hans, Didier
- Khaw, Kay-Tee
- Kröger, Heikki
- LaCroix, Andrea Z
- Leslie, William D
- Mellström, Dan
- Pasco, Julie A
- Prior, Jerilynn C
- Reid, David M
- Rivadeneira, Fernando
- Yoshimura, Noriko
- Zillikens, M Carola
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-06-17
- Volume
- 29
- Issue
- 1
- Pages
- 223-233
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- OpenAlex
- W2135808586
- Cited by
- 480
- References
- 62
- Citations by year
- 2026: 22 · 2025: 29 · 2024: 24 · 2023: 34 · 2022: 47 · 2021: 43 · 2020: 36 · 2019: 42 · 2018: 49 · 2017: 43 · 2016: 46 · 2015: 32 · 2014: 28 · 2013: 4
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- Research Bank (Australian Catholic University) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- IRIS (submittedVersion)
- Chalmers Publication Library (Chalmers University of Technology) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Chalmers Research (Chalmers University of Technology) (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Funders
- Wellcome Trust
- Cancer Research UK
- National Institute for Health and Care Research (NF-SI-0512-10114)
- Medical Research Council (MR/K006312/1)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Oncology › Cancer Risks and Factors
- Keywords
- body mass index, obesity, fracture risk, osteoporotic fractures, hip fracture, bone mineral density, fragility fractures, women, low body mass index, upper arm fractures, lower leg fractures, distal forearm fractures
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Humans, Middle Aged, Obesity, Risk, Cohort Studies, Bone Density, Body Mass Index, Fractures, Bone, Osteoporotic Fractures
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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