The association between fracture site and obesity in men: A population-Based cohort study

Authors

  • Melissa O Premaor,

    1. Department of Clinical Medicine, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
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  • Juliet E Compston,

    1. Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, UK
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  • Francesc Fina Avilés,

    1. Primary Care Department, Institut Català de la Salut, Barcelona, Spain
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  • Aina Pagès-Castellà,

    1. Primary Care Department, Institut Català de la Salut, Barcelona, Spain
    2. GREMPAL (Grup de Recerca En Malalties Prevalents de l'Aparell Locomotor) Research Group-USR Barcelona, IDIAP Jordi Gol Primary Care Research Institute – Universitat Autònoma de Barcelona, Barcelona, Spain
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  • Xavier Nogués,

    1. URFOA (Unitat de Recerca de la Fisiopatologia Òssia i Articular) and RETICEF, IMIM (Parc de Salut Mar) – Instituto de Salud Carlos III, Barcelona, Spain
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  • Adolfo Díez-Pérez,

    1. URFOA (Unitat de Recerca de la Fisiopatologia Òssia i Articular) and RETICEF, IMIM (Parc de Salut Mar) – Instituto de Salud Carlos III, Barcelona, Spain
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  • Daniel Prieto-Alhambra MD, PhD, URFOA-IMIM

    Corresponding author
    1. URFOA (Unitat de Recerca de la Fisiopatologia Òssia i Articular) and RETICEF, IMIM (Parc de Salut Mar) – Instituto de Salud Carlos III, Barcelona, Spain
    2. Oxford National Institute for Health and Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    3. Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
    • GREMPAL (Grup de Recerca En Malalties Prevalents de l'Aparell Locomotor) Research Group-USR Barcelona, IDIAP Jordi Gol Primary Care Research Institute – Universitat Autònoma de Barcelona, Barcelona, Spain
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Address correspondence to: Daniel Prieto-Alhambra, MD, PhD, URFOA-IMIM, Parc de Salut Mar, c/Dr Aiguader, 88, 2nd Floor, 08003, Barcelona, Spain. E-mail: Daniel.PrietoAlhambra@ndorms.ox.ac.uk

ABSTRACT

A site-dependent association between obesity and fracture has been reported in postmenopausal women. In this study we investigated the relationship between body mass index (BMI) and fracture at different skeletal sites in older men (≥65 years). We carried out a population-based cohort study using data from the Sistema d‘Informació per al Desenvolupament de l‘Investigació en Atenció Primària (SIDIAPQ) database. SIDIAPQ contains the primary care and hospital admission computerized medical records of >1300 general practitioners (GPs) in Catalonia (Northeast Spain), with information on a representative 30% of the population (>2 million people). In 2007, 186,171 men ≥65 years were eligible, of whom 139,419 (74.9%) had an available BMI measurement. For this analysis men were categorized as underweight/normal (BMI < 25 kg/m2, n = 26,298), overweight (25 ≤ BMI < 30 kg/m2, n = 70,851), and obese (BMI ≥ 30 kg/m2, n = 42,270). Incident fractures in the period 2007 to 2009 were ascertained using International Classification of Diseases, 10th edition (ICD-10) codes. A statistically significant reduction in clinical spine and hip fractures was observed in obese (relative risk [RR], 0.65; 95% confidence interval [CI], 0.53–0.80 and RR, 0.63; 95% CI, 0.54–0.74, respectively), and overweight men (RR, 0.77; 95% CI, 0.64–0.92 and RR, 0.63; 95% CI 0.55–0.72, respectively) when compared with underweight/normal men. Additionally, obese men had significantly fewer wrist/forearm (RR, 0.77; 95% CI, 0.61–0.97) and pelvic (RR, 0.44; 95% CI, 0.28–0.70) fractures than underweight/normal men. Conversely, multiple rib fractures were more frequent in overweight (RR, 3.42; 95% CI, 1.03–11.37) and obese (RR, 3.96; 95% CI, 1.16–13.52) men. In this population-based cohort of older men, obesity was associated with a reduced risk of clinical spine, hip, pelvis, and wrist/forearm fracture and increased risk of multiple rib fractures when compared to normal or underweight men. Further work is needed to identify the mechanisms underlying these associations.

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