Obesity and fractures

Abstract

Until recently obesity was believed to be protective against fractures. However, a report from a Fracture Liaison Clinic in the UK (2010) reported a surprisingly high proportion of obese postmenopausal women attending the clinic with fractures, and in the GLOW study (2011), a similar prevalence and incidence of fractures in obese and non-obese postmenopausal women was observed. Subsequently, other studies have demonstrated the importance of obesity in the epidemiology of fractures. Obese women are at increased risk of fracture in ankle, leg, humerus, and vertebral column and at lower risk of wrist, hip and pelvis fracture when compared to non-obese women. In men, it has been reported that multiple rib fractures are associated with obesity. Furthermore, falls appear to play an important role in the pathogenesis of fractures in obese subjects. Regarding hip fracture and major fractures, the FRAX algorithm has proven to be a useful predictor in obese individuals. Obese people are less likely to receive bone protective treatment; they have a longer hospital stay and a lower quality of life both before and after fracture. Moreover, the efficacy of antiresorptive therapies is not well established in obese people. The latter is a field for future research. Arq Bras Endocrinol Metab. 2014;58(5):470-7 Keywords Obesity; fractures; osteoporosis; osteopenia ReSumo Acreditava-se que pessoas obesas estavam protegidas contra fraturas. No entanto, um estudo realizado no Reino Unido (2010) encontrou uma proporção surpreendentemente alta de obesidade entre as mulheres na pós-menopausa que se consultaram em uma Clínica de Fraturas Ósseas. Da mesma maneira, o estudo GLOW (2011) observou prevalência e incidência semelhantes de fraturas em mulheres na pós-menopausa obesas e não obesas. Posteriormente, vários outros estudos têm demonstrado a importância da obesidade na epidemiologia de fraturas. Mulheres obesas têm maior risco de fratura no tornozelo, na perna, no úmero e na coluna vertebral e têm menor risco de fratura de punho, quadril e pelve quando comparadas às mulheres não obesas. A associação entre fraturas múltiplas de costelas e obesidade foi descrita em homens. Além disso, as quedas parecem desempenhar um papel importante na patogênese de fraturas em pacientes obesos. O algoritmo FRAX parece ser uma ferramenta útil na predição do risco de fraturas em indivíduos obesos. Indivíduos obesos são menos propensos a receber tratamento preventivo para as fraturas ósseas e, quando sofrem uma fratura óssea, sua internação costuma ser mais longa do que a internação de indivíduos magros. A qualidade de vida dos indivíduos obesos é menor antes e depois da fratura. Não obstante, a eficácia de terapias antirreabsorção não está bem estabelecida em pessoas obesas. Este último é um campo para pesquisas futuras. Arq Bras Endocrinol Metab. 2014;58(5):470-7 Descritores Obesidade; fraturas ósseas; osteoporose, osteopenia

Obesity and Chronic Pain

“…131,132 Occupational medicine literature has established that obese men are at increased risk of multiple rib fractures, and obese women are at greater risk of fracture in the vertebral column, leg, ankle, and humerus and at lesser risk of wrist, hip, and pelvis fractures. 133 …”

The impact of metabolic changes in type 2 diabetes on bone turnover.

“…PTH can affect the release of insulin by the pancreas, acting on the metabolism of insulin and glucose. Thus, with an increase in the concentration of PTH, an increase in the level of glucose in the plasma is observed [3].…”

Comparison of Metabolic Risk Factors and Physical Fitness according to Femur Osteoporotic Status in Elderly Women

“…However, fracture risk in obesity is not lower at all skeletal sites; the risk of some non-spine fractures including proximal humerus (RR 1.28), upper leg (OR 1.7) and ankle fracture (OR 1.5) is higher [4,5]. A large number of low-trauma fractures occur in overweight and obese men and women, and the prevalence of low-trauma fractures is similar in obese and non-obese women [6]. Therefore, obesity is not entirely protective against fracture, and there are some site-specific effects on fracture.…”