Divergent effects of obesity on fragility fractures

Divergent effects of obesity on fragility fractures

Carla Caffarelli, Chiara Alessi, Ranuccio Nuti, Stefano Gonnelli Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy Abstract: Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density obse...

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Autores principales: Caffarelli C, Alessi C, Nuti R, Gonnelli S
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2014
Materias:
Obesity
Fragility Fracture
Bone Mineral Density
BMI
Prevention
Geriatrics
RC952-954.6
Acceso en línea:https://doaj.org/article/61c878d8609c4987ab15f85a758696ee
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spelling oai:doaj.org-article:61c878d8609c4987ab15f85a758696ee2021-12-02T02:39:07ZDivergent effects of obesity on fragility fractures1178-1998https://doaj.org/article/61c878d8609c4987ab15f85a758696ee2014-09-01T00:00:00Zhttps://www.dovepress.com/divergent-effects-of-obesity-on-fragility-fractures-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Carla Caffarelli, Chiara Alessi, Ranuccio Nuti, Stefano Gonnelli Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy Abstract: Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm) and decreased for others (hip, pelvis, wrist). Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc) are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX® might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals. Keywords: bone mineral density, BMI, preventionCaffarelli CAlessi CNuti RGonnelli SDove Medical PressarticleObesityFragility FractureBone Mineral DensityBMIPreventionGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 1629-1636 (2014)
institution DOAJ
collection DOAJ
language EN
topic Obesity
Fragility Fracture
Bone Mineral Density
BMI
Prevention
Geriatrics
RC952-954.6
spellingShingle Obesity
Fragility Fracture
Bone Mineral Density
BMI
Prevention
Geriatrics
RC952-954.6
Caffarelli C
Alessi C
Nuti R
Gonnelli S
Divergent effects of obesity on fragility fractures
description Carla Caffarelli, Chiara Alessi, Ranuccio Nuti, Stefano Gonnelli Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy Abstract: Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm) and decreased for others (hip, pelvis, wrist). Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc) are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX® might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals. Keywords: bone mineral density, BMI, prevention
format article
author Caffarelli C
Alessi C
Nuti R
Gonnelli S
author_facet Caffarelli C
Alessi C
Nuti R
Gonnelli S
author_sort Caffarelli C
title Divergent effects of obesity on fragility fractures
title_short Divergent effects of obesity on fragility fractures
title_full Divergent effects of obesity on fragility fractures
title_fullStr Divergent effects of obesity on fragility fractures
title_full_unstemmed Divergent effects of obesity on fragility fractures
title_sort divergent effects of obesity on fragility fractures
publisher Dove Medical Press
publishDate 2014
url https://doaj.org/article/61c878d8609c4987ab15f85a758696ee
work_keys_str_mv AT caffarellic divergenteffectsofobesityonfragilityfractures
AT alessic divergenteffectsofobesityonfragilityfractures
AT nutir divergenteffectsofobesityonfragilityfractures
AT gonnellis divergenteffectsofobesityonfragilityfractures
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