title: Relationship of weight, height, and body mass index with fracture risk at different sites in postmenopausal women: the Global Longitudinal study of Osteoporosis in Women (GLOW).
abstract: Low body mass index (BMI) is a well-established risk factor for fracture in postmenopausal women. Height and obesity have also been associated with increased fracture risk at some sites. We investigated the relationships of weight, BMI, and height with incident clinical fracture in a practice-based cohort of postmenopausal women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). Data were collected at baseline and at 1, 2, and 3 years. For hip, spine, wrist, pelvis, rib, upper arm/shoulder, clavicle, ankle, lower leg, and upper leg fractures, we modeled the time to incident self-reported fracture over a 3-year period using the Cox proportional hazards model and fitted the best linear or nonlinear models containing height, weight, and BMI. Of 52,939 women, 3628 (6.9%) reported an incident clinical fracture during the 3-year follow-up period. Linear BMI showed a significant inverse association with hip, clinical spine, and wrist fractures: adjusted hazard ratios (HRs) (95% confidence intervals [CIs]) per increase of 5 kg/m(2) were 0.80 (0.71-0.90), 0.83 (0.76-0.92), and 0.88 (0.83-0.94), respectively (all p < 0.001). For ankle fractures, linear weight showed a significant positive association: adjusted HR per 5-kg increase 1.05 (1.02-1.07) (p < 0.001). For upper arm/shoulder and clavicle fractures, only linear height was significantly associated: adjusted HRs per 10-cm increase were 0.85 (0.75-0.97) (p = 0.02) and 0.73 (0.57-0.92) (p = 0.009), respectively. For pelvic and rib fractures, the best models were for nonlinear BMI or weight (p = 0.05 and 0.03, respectively), with inverse associations at low BMI/body weight and positive associations at high values. These data demonstrate that the relationships between fracture and weight, BMI, and height are site-specific. The different associations may be mediated, at least in part, by effects on bone mineral density, bone structure and geometry, and patterns of falling.
authors.affiliation: Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, UK.
authors.forename: Juliet E
authors.initials: JE
authors.lastname: Compston
authors.forename: Julie
authors.initials: J
authors.lastname: Flahive
authors.forename: David W
authors.initials: DW
authors.lastname: Hosmer
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Watts
authors.forename: Ethel S
authors.initials: ES
authors.lastname: Siris
authors.forename: Stuart
authors.initials: S
authors.lastname: Silverman
authors.forename: Kenneth G
authors.initials: KG
authors.lastname: Saag
authors.forename: Christian
authors.initials: C
authors.lastname: Roux
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.forename: Johannes
authors.initials: J
authors.lastname: Pfeilschifter
authors.forename: Jeri W
authors.initials: JW
authors.lastname: Nieves
authors.forename: J Coen
authors.initials: JC
authors.lastname: Netelenbos
authors.forename: Lyn
authors.initials: L
authors.lastname: March
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.forename: Frederick H
authors.initials: FH
authors.lastname: Hooven
authors.forename: Susan L
authors.initials: SL
authors.lastname: Greenspan
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Gehlbach
authors.forename: Adolfo
authors.initials: A
authors.lastname: Díez-Pérez
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.forename: Roland D
authors.initials: RD
authors.lastname: Chapurlat
authors.forename: Steven
authors.initials: S
authors.lastname: Boonen
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001835:Body Weight; D001842:Bone and Bones / Q000378:metabolism / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D008954:Models, Biological; D017698:Postmenopause / Q000378:metabolism*; D012307:Risk Factors
keywords: BMI; FRACTURES; OBESITY; OSTEOPOROSIS; POSTMENOPAUSAL WOMEN