Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

• Published in: PloS one Vol. 16; no. 6; p. e0252487
• Main Authors: Turcotte, Anne-Frédérique, O'Connor, Sarah, Morin, Suzanne N, Gibbs, Jenna C, Willie, Bettina M, Jean, Sonia, Gagnon, Claudia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.06.2021; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Biomedical materials; Body mass index; Body weight; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; Bone mineral density; Bones; Complications and side effects; Data Management; Density; Diabetes; Elbow; Elbow (anatomy); Endocrinology; Female; Fractures; Gastrointestinal surgery; Health risks; Humans; Humerus; Male; Medicine; Medicine and Health Sciences; Meta-analysis; Metabolism; Nephrology; Obesity; Obesity - epidemiology; Obesity - metabolism; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporosis, Postmenopausal - metabolism; Overweight; Pharmacy; Physical Sciences; Population; Research and Analysis Methods; Risk analysis; Risk assessment; Risk factors; Systematic review; Women; Canada; Montreal Quebec Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0252487

The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population. This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques). PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021. Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes. This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity. CRD42020159189.