title: Abdominal obesity increases the risk of hip fracture. A population-based study of 43,000 women and men aged 60-79 years followed for 8 years. Cohort of Norway.
abstract: BACKGROUND
  The question as to whether abdominal obesity has an adverse effect on hip fracture remains unanswered. The purpose of this study was to investigate the associations of waist circumference, hip circumference, waist-hip ratio, and body mass index with incident hip fracture.
  
  
  METHODS
  The data in this prospective study is based on Cohort of Norway, a population-based cohort established during 1994-2003. Altogether 19,918 women and 23,061 men aged 60-79 years were followed for a median of 8.1 years. Height, weight, waist and hip circumference were measured at baseline using standard procedures. Information on covariates was collected by questionnaires. Hip fractures (n = 1,498 in women, n = 889 in men) were identified from electronic discharge registers from all general hospitals in Norway between 1994 and 2008.
  
  
  RESULTS
  The risk of hip fracture decreased with increasing body mass index, plateauing in obese men. However, higher waist circumference and higher waist-hip ratio were associated with an increased risk of hip fracture after adjustment for body mass index and other potential confounders. Women in the highest tertile of waist circumference had an 86% (95% CI: 51-129%) higher risk of hip fracture compared to the lowest, with a corresponding increased risk in men of 100% (95% CI 53-161%). Lower body mass index combined with abdominal obesity increased the risk of hip fracture considerably, particularly in men.
  
  
  CONCLUSIONS
  Abdominal obesity was associated with an increased risk of hip fracture when body mass index was taken into account. In view of the increasing prevalence of obesity and the number of older people suffering osteoporotic fractures in Western societies, our findings have important clinical and public health implications.
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: A J
authors.initials: AJ
authors.lastname: Søgaard
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Holvik
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.|Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: T K
authors.initials: TK
authors.lastname: Omsland
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: G S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.|Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Dahl
authors.affiliation: Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.|Department of Obstetrics and Gynecology, St. Olavs Hospital, Trondheim, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Schei
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: J A
authors.initials: JA
authors.lastname: Falch
authors.affiliation: Osteoporosis and Bone Biology & Clinical Translation and Advanced Education, Garvan Institute of Medical Research, Sydney, NSW, Australia.|St Vincents Hospital, Sydney, NSW, Australia.|Faculty of Medicine, NSW University, Sydney, NSW, Australia.|School of Medicine Sydney, Notre Dame University, Sydney, Australia.
authors.forename: J A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.|Department of Community Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: H E
authors.initials: HE
authors.lastname: Meyer
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D056128:Obesity, Abdominal / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D049629:Waist-Hip Ratio
keywords: abdominal obesity; body mass index; hip fractures; waist circumference; waist/hip ratio