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Relationship between body mass index and fracture risk at different skeletal sites: a nationwide cohort study

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Abstract

Summary

The association between obesity and fracture was skeletal site-specific with no gender difference. Obesity was associated with a higher risk of proximal humerus fractures but not for wrist or clinical vertebral fractures.

Purpose

The association between body mass index (BMI) and the risk of clinical fractures at different sites is unclear. This study aimed to examine associations between BMI and fractures at different sites in Korean men and women.

Methods

This study analyzed 285,643 Korean adults (aged 50–80 years) who participated in health examinations from 2002 to 2003 and were followed up until 2015. The incidences of osteoporotic fractures were assessed using the International Classification of Diseases (10th revision; ICD-10) and procedure or radiographic codes. After adjusting for confounders, hazard ratios (HRs) were calculated using Cox proportional hazard models for fracture risk.

Results

Site-specific associations between BMI and fractures were found without gender difference. Specifically, an L-shaped association was found for clinical vertebral fractures, wherein the adjusted HRs per 5 kg/m2 increase were 0.80 (95% confidence interval [CI] = 0.76–0.83) in BMI groups < 25 kg/m2 and 0.97 (95% CI = 0.92–1.03) in BMI ≥ 25 kg/m2. A linear inverse correlation for wrist fractures was observed, wherein the HRs were 0.83 (95% CI = 0.81–0.86) per 5 kg/m2 increase. For proximal humerus fractures, a non-linear U-shape association was found, wherein the adjusted HRs per 5 kg/m2 increase were 0.66 (95% CI = 0.50–0.88) in BMI groups < 23 kg/m2 and 1.25 (95% CI = 1.08–1.45) in BMI ≥ 23 kg/m2.

Conclusion

Low BMI was a risk factor for all tested fractures. Obesity was a risk factor for proximal humerus fracture, but it is a protective factor for wrist fracture.

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Data availability

The data are available from the Korean National Health Insurance Service (NHIS), but access to confidential data is limited to researchers who meet the necessary criteria. Basically, any researchers who propose a study subject and plans using the standardized proposal form that is approved by the NHIS review committee of research support can access the raw data. The detailed process and a provision guide are now available at http://nhiss.nhis.or.kr/bd/ab/bdaba000eng.do.

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Acknowledgements

The authors thank the Big Data Steering Department staff at the National Health Insurance Service (NHIS) for providing the data and support. This study used NHIS-NSC data (NHIS-2021-2-073) prepared by the NHIS.

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Authors and Affiliations

  1. Department of Preventive Medicine and Public Health, Catholic Kwandong University College of Medicine, Gangneung, Republic of Korea

    Sang-Wook Yi

  2. Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Simgokro 100Gil 25, Seo-gu, Incheon, 22711, Republic of Korea

    Jae Hyun Bae, Yoo Mee Kim, Young Jun Won & Se Hwa Kim

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  1. Sang-Wook Yi
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Contributions

Study design: SW Yi and SH Kim. Data analysis: SW Yi. Data interpretation: SW Yi, JH Bae, YM Kim, YJ Won, and SH Kim. Drafting manuscript: SH Kim. All authors contributed to critical revision of the manuscript and approved the final submitted version of the manuscript. SW Yi and SH Kim take responsibility for the integrity of the data analysis.

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Correspondence to Se Hwa Kim.

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Yi, SW., Bae, J.H., Kim, Y.M. et al. Relationship between body mass index and fracture risk at different skeletal sites: a nationwide cohort study. Arch Osteoporos 17, 99 (2022). https://doi.org/10.1007/s11657-022-01147-0

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