BMI and fracture risk in older men: The osteoporotic fractures in men study (MrOS)

Abstract

Low body mass index (BMI) is a risk factor for fracture, but little is known about the association between high BMI and fracture risk. We evaluated the association between BMI and fracture in the Osteoporotic Fractures in Men Study (MrOS), a cohort of 5995 US men 65 years of age and older. Standardized measures included weight, height, and hip bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA); medical history; lifestyle; and physical performance. Only 6 men (0.1%) were underweight (<18.5 kg/m2); therefore, men in this category were excluded. Also, 27% of men had normal BMI (18.5 to 24.9 kg/m2), 52% were overweight (25 to 29.9 kg/m2), 18% were obese I (30 to 34.9 kg/m2), and 3% were obese II (35 to 39.9 kg/m2). Overall, nonspine fracture incidence was 16.1 per 1000 person-years, and hip fracture incidence was 3.1 per 1000 person-years. In age-, race-, and BMD-adjusted models, compared with normal weight, the hazard ratio (HR) for nonspine fracture was 1.04 [95% confidence interval (CI) 0.87–1.25] for overweight, 1.29 (95% CI 1.00–1.67) for obese I, and 1.94 (95% CI 1.25–3.02) for obese II. Associations were weaker and not statistically significant after adjustment for mobility limitations and walking pace (HR = 1.02, 95% CI 0.84–1.23, for overweight; HR = 1.12, 95% CI 0.86–1.46, for obese I, and HR = 1.44, 95% CI 0.90–2.28, for obese II). Obesity is common among older men, and when BMD is held constant, it is associated with an increased risk of fracture. This association is at least partially explained by worse physical function in obese men. © 2011 American Society for Bone and Mineral Research.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 48

1. 1.

   Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. 2002;359:1761-1767.

   Not in our library10.1016/s0140-6736(02)08657-9

2. 2.

   Cummings SR, Cawthon PM, Ensrud KE, et al. BMD and risk of hip and nonvertebral fractures in older men: a prospective study and comparison with older women. J Bone Miner Res. 2006;21:1550-1556.

   Not in our library10.1359/jbmr.060708

3. 3.

   Ogden CL, Carroll MD, Curtin LR, et al. Prevalence of overweight and obesity in the United States, 1999-2004. JAMA. 2006;295:1549-1555.

   Not in our library10.1001/jama.295.13.1549

4. 4.

   De Laet C, Kanis JA, Oden A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330-1338.

   Not in our library10.1007/s00198-005-1863-y

5. 5.

   Reid IR. Relationships between fat and bone. Osteoporos Int. 2008;19:595-606.

   Not in our library10.1007/s00198-007-0492-z

6. 6.

   Hsu YH, Venners SA, Terwedow HA, et al. Relation of body composition, fat mass, and serum lipids to osteoporotic fractures and bone mineral density in Chinese men and women. Am J Clin Nutr. 2006;83:146-154.

   Not in our library10.1093/ajcn/83.1.146

7. 7.

   El Maghraoui A, Mounach A, Gassim S, et al. Vertebral fracture assessment in healthy men: prevalence and risk factors. Bone. 2008;43:544-548.

   Not in our library10.1016/j.bone.2008.05.008

8. 8.

   Nguyen ND, Pongchaiyakul C, Center JR, et al. Abdominal fat and hip fracture risk in the elderly: the Dubbo Osteoporosis Epidemiology Study. BMC Musculoskelet Disord. 2005;6:11.

   Not in our library10.1186/1471-2474-6-11

9. 9.

   Holmberg AH, Johnell O, Nilsson PM, et al. Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int. 2006;17:1065-77.

   Not in our library10.1007/s00198-006-0137-7

10. 10.

    Sharma S, Fraser M, Lovell F, et al. Characteristics of males over 50 years who present with a fracture: epidemiology and underlying risk factors. J Bone Joint Surg. 2008;90:72-77.

    Not in our library10.1302/0301-620x.90b1.18773

11. 11.

    Kanis J, Johnell O, Gullberg B, et al. Risk factors for hip fracture in men from southern Europe: the MEDOS study. Mediterranean Osteoporosis Study. Osteoporos Int. 1999;9:45-54.

    Not in our library10.1007/s001980050115

12. 12.

    Gnudi S, Emanuela S, Lisi L. Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Metab. 2009;27:479-484.

    Not in our library10.1007/s00774-009-0056-8

13. 13.

    Owusu W, Willett W, Ascherio A, et al. Body anthropometry and the risk of hip and wrist fractures in men: results from a prospective study. Obes Res. 1998;6:12-19.

    Not in our library10.1002/j.1550-8528.1998.tb00309.x

14. 14.

    Orlandin Premaor M, Pilbrow L, Tonkin C, et al. Obesity and fractures in postmenopausal women. J Bone Miner Res. 2010;25:292-297.

    Not in our library10.1359/jbmr.091004

15. 15.

    Blank JB, Cawthon PM, Carrion-Petersen ML, et al. Overview of recruitment for the Osteoporotic Fractures in Men Study (MrOS). Contemp Clin Trials. 2005;26:557-568.

    Not in our library10.1016/j.cct.2005.05.005

16. 16.

    Orwoll E, Blank JB, Barrett-Connor E, et al. Design and baseline characteristics of the Osteoporotic Fractures in Men Study (MrOS)—a large observational study of the determinants of fracture in older men. Contemp Clin Trials. 2005;26:569-585.

    Not in our library10.1016/j.cct.2005.05.006

17. 17.

    Block G, Hartman AM, Naughton D. A reduced dietary questionnaire: development and validation. Epidemiology. 1990;1:58-64.

    Not in our library10.1097/00001648-199001000-00013

18. 18.

    Washburn RA, Smith KW, Jette AM, et al. The Physical Activity Scale for the Elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46:153-162.

    Not in our library10.1016/0895-4356(93)90053-4

19. 19.

    Bassey EJ, Short AH. A new method for measuring power output in a single leg extension: feasibility, reliability and validity. Eur J Appl Physiol Occup Physiol. 1990;60:385-390.

    Not in our library10.1007/bf00713504

20. 20.

    Pahor M, Chrischilles EA, Guralnik JM, et al. Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol. 1994;10:405-411.

    Not in our library10.1007/bf01719664

21. 21.

    Heymsfield SB, Gallagher D, Visser M, et al. Measurement of skeletal muscle: laboratory and epidemiological methods. J Gerontol A Biol Sci Med Sci. 1995;50.

    Not in our library10.1093/gerona/50a.special_issue.23

22. 22.

    Baumgartner RN, Stauber PM, McHugh D, et al. Body composition in the elderly using multicompartmental methods. Basic Life Sci. 1993;60:251-254.

    Not in our library10.1007/978-1-4899-1268-8_56

23. 23.

    Sanders KM, Pasco JA, Ugoni AM, et al. The exclusion of high trauma fractures may underestimate the prevalence of bone fragility fractures in the community: the Geelong Osteoporosis Study. J Bone Miner Res. 1998;13:1337-1342.

    Not in our library10.1359/jbmr.1998.13.8.1337

24. 24.

    Mackey DC, Lui LY, Cawthon PM, et al. High-trauma fractures and low bone mineral density in older women and men. JAMA. 2007;298:2381-2388.

    Not in our library10.1001/jama.298.20.2381

25. 25.

    Heinzl H, Kaider A. Gaining more flexibility in Cox proportional hazards regression models with cubic spline functions. Comput Methods Programs Biomed. 1997;54:201-208.

    Not in our library10.1016/s0169-2607(97)00043-6

26. 26.

    McDowell MA, Fryar CD, Hirsch R, et al. 2005.

    Not in our library

27. 27.

    Chan BK, Marshall LM, Winters KM, et al. Incident fall risk and physical activity and physical performance among older men: the Osteoporotic Fractures in Men Study. Am J Epidemiol. 2007;165:696-703.

    Not in our library10.1093/aje/kwk050

28. 28.

    Sai A, Gallagher JC, Smith LM, et al. Fall predictors in the community dwelling elderly: a cross sectional and prospective cohort study. J Musculoskelet Neuronal Interact. 2010;10:142-150.

    Not in our library

29. 29.

    Close JC, Hooper R, Glucksman E, et al. Predictors of falls in a high risk population: results from the prevention of falls in the elderly trial (PROFET). Emerg Med J. 2003;20:421-425.

    Not in our library10.1136/emj.20.5.421

30. 30.

    Kim YM, Hyun NR, Shon HS, et al. Assessment of clinical risk factors to validate the probability of osteoporosis and subsequent fractures in Korean women. Calcif Tissue Int. 2008;83:380-387.

    Not in our library10.1007/s00223-008-9182-x

31. 31.

    Beck TJ, Petit MA, Wu G, et al. Does obesity really make the femur stronger? Bone mineral density, geometry, and fracture incidence in the Women's Health Initiative Observational Study. J Bone Miner Res. 2009;24:1369-1379.

    Not in our library10.1359/jbmr.090307

32. 32.

    Nielson CM, Marshall LM, Cawthon PM, et al. 2009.

    Not in our library

33. 33.

    Gilsanz V, Chalfant J, Mo AO, et al. Reciprocal relations of subcutaneous and visceral fat to bone structure and strength. J Clin Endocrinol Metab. 2009;94:3387-3393.

    Not in our library10.1210/jc.2008-2422

34. 34.
    The influence of obesity on falls and quality of life · 2008

    No notice
35. 35.

    Freidmann JM, Elasy T, Jensen JL. The relationship between body mass index and self-reported functional limitation among older adults: a gender difference. J Am Geriatr Soc. 2001;49:398-403.

    Not in our library10.1046/j.1532-5415.2001.49082.x

36. 36.

    Bouxsein ML, Szulc P, Munoz F, et al. Contribution of trochanteric soft tissues to fall force estimates, the factor of risk, and prediction of hip fracture risk. J Bone Miner Res. 2007;22:825-831.

    Not in our library10.1359/jbmr.070309

37. 37.

    Nielson CM, Bouxsein ML, Freitas SS, et al. Trochanteric soft tissue thickness and hip fracture in older men. J Clin Endocrinol Metab. 2009;94:491-496.

    Not in our library10.1210/jc.2008-1640

38. 38.

    Orwoll E, Nielson CM, Marshall LM, et al. Vitamin D deficiency in older men. J Clin Endocrinol Metab. 2009;94:1214-1222.

    Not in our library10.1210/jc.2008-1784

39. 39.

    Bjorntorp P, Rosmond R. Neuroendocrine abnormalities in visceral obesity. Int J Obes Relat Metab Disord. 2000;24(Suppl 2):S80-5.

    Not in our library10.1038/sj.ijo.0801285

40. 40.

    LeBlanc ES, Nielson CM, Marshall LM, et al. The effects of serum testosterone, estradiol, and sex hormone binding globulin levels on fracture risk in older men. J Clin Endocrinol Metab. 2009;94:3337-3346.

    Not in our library10.1210/jc.2009-0206

41. 41.

    Cauley JA, Parimi N, Ensrud KE, et al. Serum 25-hydroxyvitamin D and the risk of hip and nonspine fractures in older men. J Bone Miner Res. 2010;25:545-553.

    Not in our library10.1359/jbmr.090826

42. 42.

    Ensrud KE, Fullman RL, Barrett-Connor E, et al. Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab. 2005;90:1998-2004.

    Not in our library10.1210/jc.2004-1805

43. 43.

    Langlois JA, Visser M, Davidovic LS, et al. Hip fracture risk in older white men is associated with change in body weight from age 50 years to old age. Arch Intern Med. 1998;158:990-996.

    Not in our library10.1001/archinte.158.9.990

44. 44.

    Di Monaco M, Vallero F, Di Monaco R, et al. Body composition and hip fracture type in elderly women. Clin Rheumatol. 2004;23:6-10.

    Not in our library10.1007/s10067-003-0750-1

45. 45.

    Leibson CL, Tosteson AN, Gabriel SE, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc. 2002;50:1644-1650.

    Not in our library10.1046/j.1532-5415.2002.50455.x

46. 46.

    Magaziner J, Fredman L, Hawkes W, et al. Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol. 2003;157:1023-1031.

    Not in our library10.1093/aje/kwg081

47. 47.

    Visser M, Langlois J, Guralnik JM, et al. High body fatness, but not low fat-free mass, predicts disability in older men and women: the Cardiovascular Health Study. Am J Clin Nutr. 1998;68:584-590.

    Not in our library10.1093/ajcn/68.3.584

48. 48.

    Fransen M, Woodward M, et al. Excess mortality or institutionalization after hip fracture: men are at greater risk than women. J Am Geriatr Soc. 2002;50:685-690.

    Not in our library10.1046/j.1532-5415.2002.50163.x

Cited by papers we hold 4

• The Effects of 12-Weeks Whey Protein Supplements on Markers of Bone Turnover in Adults With Abdominal Obesity – A Post Hoc Analysis · 2022
  Not checked
• Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry—part II (clinical aspects): interpretation, reporting, and special situations · 2022
  Not checked
• Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis · 2021
  No notice
• Obesity and Risk of Hip Fracture in Adults: A Meta-Analysis of Prospective Cohort Studies · 2013
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.