Relationship Between Mortality and BMI After Fracture: A Population-Based Study of Men and Women Aged ≥40 Years

Authors

  • Daniel Prieto-Alhambra,

    Corresponding author
    1. Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL), Informació pel Desenvolupament de la Investigació en Atenció Primària (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
    2. Unitat de Recerca en Fisiopatologia Òssia i Articular (URFOA), Institut Municipal d'Investigacions Mèdiques, Parc de Salut Mar, Barcelona, Spain
    3. Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    4. Primary Care Department, Institut Català de la Salut, Barcelona, Spain
    5. Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto Carlos III, Barcelona, Spain
    • Address correspondence to: Daniel Prieto-Alhambra, MD, PhD, Musculoskeletal Epidemiology Group, Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Nuffield Orthopaedic Centre, Windmill Road, OX3 7LD, Oxford, UK.

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  • Melissa O Premaor,

    1. Department of Clinical Medicine, Health Sciences Center, Federal University of Santa Maria, Santa Maria, Brazil
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  • Francesc Fina Avilés,

    1. Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL), Informació pel Desenvolupament de la Investigació en Atenció Primària (IDIAP) Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
    2. Primary Care Department, Institut Català de la Salut, Barcelona, Spain
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  • Alberto Soria Castro,

    1. Primary Care Department, Institut Català de la Salut, Barcelona, Spain
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  • M Kassim Javaid,

    1. Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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  • Xavier Nogués,

    1. Unitat de Recerca en Fisiopatologia Òssia i Articular (URFOA), Institut Municipal d'Investigacions Mèdiques, Parc de Salut Mar, Barcelona, Spain
    2. Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto Carlos III, Barcelona, Spain
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  • Nigel K Arden,

    1. Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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  • Cyrus Cooper,

    1. Oxford National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    2. Medical Research Council (MRC) Lifecourse Epidemiology Unit, Southampton, UK
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  • Juliet E Compston,

    1. Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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  • Adolfo Diez-Perez

    1. Unitat de Recerca en Fisiopatologia Òssia i Articular (URFOA), Institut Municipal d'Investigacions Mèdiques, Parc de Salut Mar, Barcelona, Spain
    2. Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto Carlos III, Barcelona, Spain
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ABSTRACT

Fractures in obese older individuals contribute significantly to the overall burden on primary health care, but data on their impact on mortality are lacking. We studied the association between obesity and mortality following hip and nonhip clinical fractures in a retrospective, population-based cohort study. The Sistema d'Informació pel Desenvolupament de la Investigació en Atenció Primària (SIDIAPQ) database contains primary care computerized medical records of a representative sample of >2.1 million people (35% of the population) in Catalonia (Spain), linked to hospital admissions data. We included in this analysis anyone aged 40 years and older suffering a hip or nonhip clinical fracture in 2007 to 2009 in the SIDIAPQ database. The main exposure was the most recent body mass index (BMI) measured before fracture, categorized as underweight (<18.5 kg/m2), normal (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), and obese (≥30 kg/m2). Furthermore, the study outcome was all-cause mortality in 2007 to 2009 as provided to SIDIAPQ by the National Office of Statistics. Time to death after fracture was modeled using Cox regression. Multivariate models were adjusted for age, gender, smoking, alcohol intake, oral glucocorticoid use, and Charlson comorbidity index. Within the study period, 6988 and 29,372 subjects with a hip or nonhip clinical fracture were identified and followed for a median (interquartile range) of 1.17 (0.53–2.02) and 1.36 (0.65–2.15) years, respectively. Compared to subjects of normal weight, adjusted hazard ratios (HRs) for mortality in overweight and obese subjects were 0.74 (95% CI, 0.62–0.88; p = 0.001) and 0.74 (95% CI, 0.60–0.91; p = 0.004) after hip and 0.50 (95% CI, 0.32–0.77; p = 0.002), 0.56 (95% CI, 0.36–0.87; p = 0.010) after nonhip fracture. In conclusion, the highest mortality was observed in individuals with low BMI, but compared to subjects of normal weight, obese and overweight individuals survived longer following fracture. The latter observation is consistent with data reported in other chronic conditions, but the reasons for reduced mortality in obese and overweight subjects when compared to those of normal weight require further research. © 2014 American Society for Bone and Mineral Research.

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