Top

Osteoporosis International

Published in:

01-03-2009 | Original Article

Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years

Authors: S. Morin, J. F. Tsang, W. D. Leslie

Published in: Osteoporosis International | Issue 3/2009

Abstract

Summary

Weight and body mass index are associated with low bone mineral density and fractures in older women. This retrospective cohort study confirms a similar relationship in women aged 40 to 59 years.

Introduction

Risk factors for the prediction of osteoporosis and fractures have been less thoroughly studied in younger women. We evaluated the associations between weight, body mass index (BMI), the Osteoporosis Self-Assessment Tool (OST), bone mineral density (BMD) and fracture risk in women aged 40 to 59 years.

Methods

Using administrative health management databases, we conducted a retrospective cohort study in 8,254 women aged 40–59 years who had baseline BMD testing. Linear regression and Cox proportional multivariate models were created to examine the associations with weight, BMI, OST, BMD, and subsequent fractures throughout a 3.3-year follow-up.

Results

Body weight, BMI, and OST had a similar overall performance in their ability to classify women with femoral neck T-score ≤ −2.5. Throughout 27,256 person years of observation, 225 women experienced one or more fractures. After adjustment for age, prevalent fractures, and use of corticosteroids, each standard deviation decrease in weight was associated with a 19% increase in the risk of incident fracture (95% CI: 1.01–1.35). Femoral neck BMD and the presence of prevalent fractures were also associated with the risk of incident fractures.

Conclusions

Low weight and BMI predict osteoporosis and are associated with increased fracture risk in younger women. The negative impact of low body weight on bone health should be more widely recognized.

Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRef

Brown JP, Josse RG (2002) 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 167:S1–S34PubMed

National Osteoporosis Foundation (2003) Physician's guide to the prevention and treatment of osteoporosis. National Osteoporosis Foundation, Washington, DC

Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936PubMedCrossRef

Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE et al (1995) Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med 332:767–73PubMedCrossRef

Van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000PubMedCrossRef

Kanis JA, Borgstrom F, De Laet C, Johansson H, Johnell O, Jonsson B et al (2005) Assessment of fracture risk. Osteoporos Int 16:581–89PubMedCrossRef

Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J et al (2007) The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 18:1033–1046PubMedCrossRef

Reid IR (2002) Relationships among body mass, its components and bone. Bone 31:547–555PubMedCrossRef

10.

Felson DT, Zhang Y, Hannan MT, Anderson JJ (1993) Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res 8:567–573PubMedCrossRef

11.

De Laet C, Kanis JA, Oden A, Johanson H, Johnell O, Delmas P et al (2005) Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int 16:1330–1338PubMedCrossRef

12.

Johnell O, O'Neill T, Felsenberg D, Kanis J, Cooper C, Silman AJ (1997) Anthropometric measurements and vertebral deformities. European Vertebral Osteoporosis Study (EVOS) Group. Am J Epidemiol 146:287–293PubMed

13.

Williams AR, Weiss NS, Ure CL, Ballard J, Daling JR (1982) Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol 60:695–699PubMed

14.

Roy DK, O'Neill TW, Finn JD, Lunt M, Silman AJ, Felsenberg D et al (2003) Determinants of incident vertebral fracture in men and women: results from the European Prospective Osteoporosis Study (EPOS). Osteoporos Int 14:19–26PubMedCrossRef

15.

Leslie WD, Metge C (2003) Establishing a regional bone density program: lessons from the Manitoba experience. J Clin Densitom 6:275–282PubMedCrossRef

16.

Leslie WD, Caetano PA, Macwilliam LR, Finlayson GS (2005) Construction and validation of a population-based bone densitometry database. J Clin Densitom 8:25–30PubMedCrossRef

17.

Roos LL, Walld RK, Romano PS, Roberecki S (1996) Short-term mortality after repair of hip fracture. Do Manitoba elderly do worse? Med Care 34:310–326PubMedCrossRef

18.

Roos LL, Mustard CA, Nicol JP, McLerran DF, Malenka DJ, Young TK et al (1993) Registries and administrative data: organization and accuracy. Med Care 31:201–212PubMedCrossRef

19.

Leslie WD (2006) The importance of spectrum bias on bone density monitoring in clinical practice. Bone 39:361–368PubMedCrossRef

20.

Binkley N, Kiebzak GM, Lewiecki EM, Krueger D, Gangnon RE, Miller PD et al (2005) Recalculation of the NHANES database SD improves T-score agreement and reduces osteoporosis prevalence. J Bone Miner Res 20:195–201PubMedCrossRef

21.

Hansen KE, Binkley N, Christian R, Vallarta-Ast N, Krueger D, Drezner MK et al (2005) Interobserver reproducibility of criteria for vertebral body exclusion. J Bone Miner Res 20:501–508PubMedCrossRef

22.

Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP (2001) Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA 286:57–63PubMedCrossRef

23.

Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP et al (2001) A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 12:699–705PubMedCrossRef

24.

Gourlay ML, Miller WC, Richy F, Garrett JM, Hanson LC, Reginster JY (2005) Performance of osteoporosis risk assessment tools in postmenopausal women aged 45–64 years. Osteoporos Int 16:921–927PubMedCrossRef

25.

Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995PubMedCrossRef

26.

Leslie WD, Tsang JF, Caetano PA, Lix LM (2007) Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. J Clin Endocrinol Metab 92:77–81PubMedCrossRef

27.

DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845PubMedCrossRef

28.

Hawker GA, Jamal SA, Ridout R, Chase C (2002) A clinical prediction rule to identify premenopausal women with low bone mass. Osteoporos Int 13:400–406PubMedCrossRef

29.

Kanis J, Johnell O, Oden A, Johansson H, Eisman J, Fujiwara S et al. (2006) The use of multiple sites for the diagnosis of osteoporosis. Osteoporos Int 17:527–534PubMedCrossRef

30.

Leslie WD, Lix LM, Tsang JF, Caetano PA (2007) Single-site vs multisite bone density measurement for fracture prediction. Arch Intern Med 167:1641–1647PubMedCrossRef

31.

Rud B, Hilden J, Hyldstrup L, Hrobjartsson A (2007) Performance of the Osteoporosis Self-Assessment Tool in ruling out low bone mineral density in postmenopausal women: a systematic review. Osteoporos Int 18:1177–1187PubMedCrossRef

32.

Gourlay ML, Powers JM, Lui LY, Ensrud KE (2008) Clinical performance of osteoporosis risk assessment tools in women aged 67 years and older. Osteoporos Int doi:10.1007/s00198-007-0555-1

33.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E (2008) FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 19:385–397PubMedCrossRef

34.

Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P et al (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35:375–382PubMedCrossRef

35.

Pepe MS, Feng Z, Huang Y, Longton G, Prentice R, Thompson IM et al (2008) Integrating the predictiveness of a marker with its performance as a classifier. Am J Epidemiol 167:362–368PubMedCrossRef

36.

Vescovi JD, Jamal SA, De Souza MJ (2008) Strategies to reverse bone loss in women with functional hypothalamic amenorrhea: a systematic review of the literature. Osteoporos Int 19:465–478PubMedCrossRef

37.

Ensrud KE, Cauley J, Lipschutz R, Cummings SR (1997) Weight change and fractures in older women. Study of Osteoporotic Fractures Research Group. Arch Intern Med 157:857–863PubMedCrossRef

38.

Siminoski K, Leslie WD, Frame H, Hodsman A, Josse RG, Khan A et al (2005) Recommendations for bone mineral density reporting in Canada. Can Assoc Radiol J 56:178–188PubMed

Title: Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years
Authors: S. Morin
J. F. Tsang
W. D. Leslie
Publication date: 01-03-2009
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 3/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-008-0688-x

At a glance: The STEP trials

Springer Medicine

Weight and body mass index predict bone mineral density and fractures in women aged 40 to 59 years

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2009

Reviewers 2008

Vitamin D deficiency in patients with active systemic lupus erythematosus

Poverty is a risk factor for osteoporotic fractures

Osteoporotic fractures and hospitalization risk in chronic spinal cord injury

Design of the POSSIBLE US™ Study: postmenopausal women’s compliance and persistence with osteoporosis medications

Case finding for the management of osteoporosis with FRAX®—assessment and intervention thresholds for the UK