The results of this study demonstrate that obesity is not protective against fracture in postmenopausal women and is associated with increased risk of ankle and upper leg fractures. These findings have major public health implications in view of the rapidly rising incidence of obesity.
Abstract
Objective
To investigate the prevalence and incidence of clinical fractures in obese, postmenopausal women enrolled in the Global Longitudinal study of Osteoporosis in Women (GLOW).
Methods
This was a multinational, prospective, observational, population-based study carried out by 723 physician practices at 17 sites in 10 countries. A total of 60,393 women aged ≥55 years were included. Data were collected using self-administered questionnaires that covered domains that included patient characteristics, fracture history, risk factors for fracture, and anti-osteoporosis medications.
Results
Body mass index (BMI) and fracture history were available at baseline and at 1 and 2 years in 44,534 women, 23.4% of whom were obese (BMI ≥30 kg/m2). Fracture prevalence in obese women at baseline was 222 per 1000 and incidence at 2 years was 61.7 per 1000, similar to rates in nonobese women (227 and 66.0 per 1000, respectively). Fractures in obese women accounted for 23% and 22% of all previous and incident fractures, respectively. The risk of incident ankle and upper leg fractures was significantly higher in obese than in nonobese women, while the risk of wrist fracture was significantly lower. Obese women with fracture were more likely to have experienced early menopause and to report 2 or more falls in the past year. Self-reported asthma, emphysema, and type 1 diabetes were all significantly more common in obese than nonobese women with incident fracture. At 2 years, 27% of obese women with incident fracture were receiving bone protective therapy, compared with 41% of nonobese and 57% of underweight women.
Conclusions
Our results demonstrate that obesity is not protective against fracture in postmenopausal women and is associated with increased risk of ankle and upper leg fractures.
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-- -- Juliet E. Compston, MD, Nelson B. Watts, MD, Roland Chapurlat, MD, PhD, Cyrus Cooper, MD, Steven Boonen, MD, PhD, Susan Greenspan, MD, Johannes Pfeilschifter, MD, Stuart Silverman, MD, Adolfo Díez-Pérez, MD, PhD, Robert Lindsay, MD, PhD, Kenneth G. Saag, MD, J. Coen Netelenbos, MD, PhD, Stephen Gehlbach, MD, Frederick H. Hooven, PhD, Julie Flahive, MS, Jonathan D. Adachi, MD, Maurizio Rossini, MD, Andrea Z. LaCroix, PhD, Christian Roux, MD, PhD, Philip N. Sambrook, MD, Ethel S. Siris, MD, Glow Investigators
This is an article originally appeared in
November 2011 issue of
The American Journal of Medicine.
