Severity of underweight and risk of fracture: a Korean nationwide population-based cohort study

Han, Sangsoo; Park, Ji Won; Nah, Sangun; Jang, Hae‐Dong; Han, Kyungdo; Hong, Jae‐Young

doi:10.1038/s41598-022-14267-x

Cited by 12 publications

(13 citation statements)

References 29 publications

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“…Our previous investigation identified low body weight as a risk factor for increased fractures [ 5 ]; however, the mechanism by which low body weight increases the frequency of fractures remains unclear. We hypothesized that malnutrition is usually associated with being underweight in humans, thereby inducing osteoporosis [ 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is because most cases of hip, wrist, and other fractures are diagnosed in hospitals, whereas vertebral fractures are often asymptomatic. To be as precise as possible, we used the operational definitions used in several previous studies [ 5 , 23 , 24 ]. Validation studies are the best techniques for confirming the given algorithm for diagnostic codes.…”

Section: Discussionmentioning

confidence: 99%

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Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study

et al. 2023

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Background Low body weight is associated with an increased risk of fractures. However, the effect of temporal changes in the low body weight status on the risk of fracture remains unknown. This study aimed to evaluate the relationships between temporal changes in low body weight status and the risk of fractures in adults over the age of 40 years. Methods This study included data on adults over 40 years old who underwent two biannual consecutive general health examinations between January 1, 2007 and December 31, 2009 extracted from the National Health Insurance Database, a large nationwide population database. Fracture cases in this cohort were monitored from the time of the last health examination to the end of the designated follow-up period (from January 1, 2010 to December 31, 2018) or the participant's death. Fractures were defined as any fracture resulting in hospitalization or outpatient treatment claim after the date of general health screening. The study population was then separated into four groups based on the temporal changes in low body weight status as follows: low body weight to low body weight (L-to-L), low body weight to non-low body weight (L-to-N), non-low body weight to low body weight (N-to-L), and non-low body weight to non-low body weight (N-to-N). The hazard ratios (HRs) for new fractures, depending on weight changes over time, were calculated using Cox proportional hazard analysis. Results Adults in the L-to-L, N-to-L, and L-to-N groups had a substantially increased risk of fractures after multivariate adjustment (HR, 1.165; 95% confidence interval [CI], 1.113–1.218; HR, 1.193; 95% CI, 1.131–1.259; and HR, 1.114; 95% CI, 1.050–1.183, respectively). Although the adjusted HR was greater in participants who changed into having a low body weight, followed by those with consistently low body weight, those with low body weight remained to have an elevated risk of fracture independent of weight fluctuation. Elderly men (aged over 65 years), high blood pressure, and chronic kidney disease were significantly associated with an increase in fractures (p < 0.05). Conclusion Individuals aged over 40 years with low body weight, even after regaining normal weight, had an increased risk of fracture. Moreover, having a low body weight after having a normal body weight increased the risk of fractures the most, followed by those with consistently low body weight.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study

et al. 2023

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“…An accurate operating definition of the code for hip fracture is important. In this study, the operating definition of several previously published studies was referred to [ 11 , 12 , 13 , 32 , 33 ]. Finally, caution is warranted when generalizing these results to countries other than Korea.…”

Section: Discussionmentioning

confidence: 99%

“…Both a single record of being underweight and accumulated records may increase the risk for disease [ 10 ]. The authors of this study studied the relationship between being underweight and hip fractures using a large-scale cohort, and reported the degree of underweight at one time or the risk of hip fractures according to changes in underweight [ 11 , 12 , 13 ]. However, the relationship between the accumulation of the underweight burden and hip fractures has not been studied.…”

Section: Introductionmentioning

confidence: 99%

Cumulative Burden of Being Underweight Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study

et al. 2022

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(1) Background: Being underweight is a known risk factor for hip fractures. However, it is unclear whether the cumulative underweight burden affects the incidence of hip fractures. Therefore, we explored the effect of the cumulative underweight burden on the development of hip fractures; (2) Methods: In a cohort of adults aged 40 years and older, 561,779 participants who were not underweight and had no hip fractures from 2007 to 2009 were identified. The risk of hip fracture from the time of the last examination to December 2018 according to the cumulative burden of being underweight (based on 0 to 3 examinations) was prospectively analyzed; (3) Results: During follow-up (mean 8.3 ± 0.8 years), the prevalence of newly diagnosed hip fractures was 0.2%, 0.4%, 0.5%, and 0.9% among those with 0, 1, 2, and 3 cumulative underweight, respectively. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of groups meeting the diagnostic criteria for underweight 1, 2, and 3 compared to 0 were 2.3 (1.6–3.3), 2.9 (1.8–4.5), and 4.5 (3.4–6.1), respectively (p for trend < 0.01); (4) Conclusions: The risk of hip fracture increased as the burden of underweight accumulated.

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“… 15 In addition, there is no study on the incidence of VFs in relation to the status change of low body weight, nor is there a large-scale study in East Asia examining the association between low body weight and VFs. Using data from the population-based, nationwide Korean National Health Insurance Service (KNHIS) database, we previously studied the association between the severity of underweight and all types of fractures, 16 as well as the relationship between changes in underweight status and hip fractures. 17 18 …”

Section: Introductionmentioning

confidence: 99%

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

Park

Han

et al. 2023

J Korean Med Sci

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Background Although, being underweight is commonly associated with osteoporosis and sarcopenia, its association with vertebral fractures (VFs), is less well researched. We investigated the influence of cumulative, chronic periods of low weight and changes in body weight on VF development. Methods We used a nationwide, population-based database with data on people (> 40 years) who attended three health screenings between January 1, 2007, and December 31, 2009 to assess the incidence of new VFs. Cox proportional hazard analyses were used to establish the hazard ratios (HRs) for new VFs based on the degree of body mass index (BMI), the cumulative numbers of underweight participants, and temporal change in weight. Results Of the 561,779 individuals in this analysis, 5,354 (1.0%) people were diagnosed three times, 3,672 (0.7%) were diagnosed twice, and 6,929 (1.2%) were diagnosed once. The fully adjusted HR for VFs in underweight individuals was 1.213. Underweight individuals diagnosed only once, twice, or three times had an adjusted HR of 0.904, 1.443, and 1.256, respectively. Although the adjusted HR was higher in adults who were consistently underweight, there was no difference in those who experienced a temporal change in body weight. BMI, age, sex, and household income were significantly associated with VF incidence. Conclusion Low weight is a risk factor for VFs in the general population. Given the significant correlation between cumulative periods of low weight and the risk of VFs, it is necessary to treat underweight patients before a VF to prevent its development and other osteoporotic fractures.

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Severity of underweight and risk of fracture: a Korean nationwide population-based cohort study

Cited by 12 publications

References 29 publications

Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study

Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study

Cumulative Burden of Being Underweight Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study

The Impact of Persistent Low Weight Status on the Occurrence of Vertebral Fractures: A Nationwide Population-Based Cohort Study

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