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Source: DGNews  |  Posted 10 years ago

Obesity a Risk Factor for Fractures in Postmenopausal Women

: Presented at ASBMR

By Nancy A. Melville

SAN DIEGO -- September 20, 2011 -- As many as 1 in 4 postmenopausal women with an incident clinical fracture is obese, according to new findings from the Global Longitudinal Study of Osteoporosis in Women (GLOW) presented here at the American Society of Bone and Mineral Research (ASBMR) 2011 Annual Meeting.

While obesity is widely believed to be a protective factor in the risk of fracture, this finding challenges that view.

“Falls are particularly likely to be important,” explained lead author Juliet Compston, MD, University of Cambridge, School of Clinical Medicine, Cambridge, England, speaking here on September 16. “Obese people fall more heavily, and are less able to protect themselves when they fall.”

Researchers evaluating fracture history and body mass index (BMI) among 44,534 women in the multinational, prospective GLOW study found that 23.4% of the subjects were obese (body mass index [BMI] over 30 kg/m2), 74.9% were not obese (BMI 18.5-29.9 kg/m2), and 1.7% were underweight (BMI under 18.5 kg/m2).

Fractures in obese women accounted for 22% of all incident fractures over the 2-year follow-up period, with higher BMI associated with ankle (P <.001) and lower-leg fractures (P =.02). Obesity was inversely related to wrist ([]P[] =.01) and pelvis fractures (P =.02).

Among women who were obese, the prevalence of fractures at baseline was 222 per 1,000 and the incidence over 2 years was 61.7 per 1,000 -- similar to rates in nonobese women (227 and 66.0 per 1,000, respectively).

Obese and nonobese women also had similar rates of previous fractures (42% and 39%, respectively).

Obese women with incident fracture were more likely than nonobese women to have experienced early menopause and to report 2 or more falls in the past year (P <.001).

“We also have evidence that obese women fall more frequently than nonobese women,” added Dr. Compston.

Women with a higher BMI had significantly higher rates of comorbidities including self-reported asthma, osteoarthritis, and type 1 diabetes (P <.001).

Treatment with bone-protective medication, at the 2-year follow-up, was low among obese women with incident fracture, at just 27% compared with 41% of nonobese and 57% of underweight women.

Falls can have more serious implications in obese women, compared to those with normal BMI, for several reasons, Dr. Compston noted. “Fractures in obese women have a higher morbidity than in nonobese [women] because of a greater risk of nonunion, complications of surgery, and longer rehabilitation times.”

The authors added that, as obesity continues to spread, more attention should be paid to the implications of a potentially greater risk of fractures and falling in the obese and overweight population.

“Our results demonstrate that nearly 1 in 4 postmenopausal women with an incident clinical fracture is obese, and that obesity is a risk factor for fractures of the lower leg and ankle,” the authors concluded.

They added that their findings have major public health implications in view of the rapidly rising incidence of obesity. Further studies are required to establish the pathogenesis of fractures in the obese population and to develop effective strategies for their prevention.

[Presentation title: Fracture Incidence in Obese Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women. Abstract 0377]

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