Incidence and predictors of fractures in older adults with and without obesity defined by body mass index versus body fat percentage

Journal article

Gandham, Anoohya, Zengin, Ayse, Bonham, Maxine P., Winzenberg, Tania, Balogun, Saliu, Wu, Feitong, Aitken, Dawn, Cicuttini, Flavia, Ebeling, Peter R., Jones, Graeme and Scott, David. (2020). Incidence and predictors of fractures in older adults with and without obesity defined by body mass index versus body fat percentage. Bone. 140, p. Article 115546. https://doi.org/10.1016/j.bone.2020.115546
AuthorsGandham, Anoohya, Zengin, Ayse, Bonham, Maxine P., Winzenberg, Tania, Balogun, Saliu, Wu, Feitong, Aitken, Dawn, Cicuttini, Flavia, Ebeling, Peter R., Jones, Graeme and Scott, David
Abstract

Purpose
The aim of this study was to determine and compare risk factors associated with incident fractures in older adults with and without obesity, defined by both body mass index (BMI) and body fat percentage.

Methods
1,099 older adults (mean ± standard deviation age = 63.0 ± 7.5) years, participated in this prospective cohort study. Obesity status at baseline was defined by BMI (≥30 kg/m2) obtained by anthropometry and body fat percentage (≥30% for men and ≥40% for women) assessed by dual-energy X-ray absorptiometry (DXA). Total hip and lumbar spine areal bone mineral density (aBMD) were assessed by DXA up to five years. Incident fractures were self-reported up to 10 years.

Results
Prevalence of obesity was 28% according to BMI and 43% according to body fat percentage. Obese older adults by BMI, but not body fat percentage, had significantly higher aBMD at the total hip and spine compared with non-obese (both p-value<0.05). Obese older adults by body fat percentage had significantly higher likelihood of all incident fractures (OR: 1.71; CI:1.08, 2.71) and non-vertebral fractures (OR: 1.88; CI:1.16, 3.04) compared with non-obese after adjusting for confounders. Conversely, obese older adults by BMI had a significantly lower likelihood (OR: 0.54; CI:0.31, 0.94) of non-vertebral fractures although this was no longer significant after adjustment for total hip aBMD (all p-value > 0.05). Mediation analysis confirmed that aBMD meditated the effects of BMI, but not body fat percentage, on all incident fractures. Higher baseline falls risk score was the only consistent predictor of increased likelihood of incident fracture in obese individuals only, according to both BMI and body fat percentage (both p-value<0.05).

Conclusions
Obesity defined by body fat percentage is associated with increased likelihood of incident fractures in community-dwelling older adults, whereas those who are obese according to BMI have reduced likelihood of incident fracture which appears to be explained by higher aBMD. Falls risk assessment may improve identification of obese older adults at increased risk of incident fractures.

Keywordsobesity; older adults; bone; fracture; aging
Year2020
JournalBone
Journal citation140, p. Article 115546
PublisherElsevier Inc.
ISSN8756-3282
Digital Object Identifier (DOI)https://doi.org/10.1016/j.bone.2020.115546
Scopus EID2-s2.0-85089245583
Research or scholarlyResearch
Page range1-7
FunderNational Health and Medical Research Council (NHMRC)
Arthritis Foundation of Australia
Tasmanian Community Fund
University of Tasmania (UTAS)
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online27 Jul 2020
Publication process dates
Accepted10 Jul 2020
Deposited25 Aug 2022
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