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Meta-Analysis
. 2021 Jun 8;16(6):e0252487.
doi: 10.1371/journal.pone.0252487. eCollection 2021.

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

Anne-Frédérique Turcotte  1   2   3 , Sarah O'Connor  4   5   6 , Suzanne N Morin  7 , Jenna C Gibbs  8 , Bettina M Willie  9 , Sonia Jean  3   6 , Claudia Gagnon  1   2   3
Affiliations
Meta-Analysis

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

Anne-Frédérique Turcotte et al. PLoS One. .

Abstract

Background: The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population.

Objectives: This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques).

Data sources: PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021.

Data synthesis: Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes.

Conclusions: This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity.

Systematic review registration number: CRD42020159189.

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Conflict of interest statement

No authors have competing interests.

Figures

Fig 1
Fig 1. Flow chart of study selection process.
Fig 2
Fig 2
Forest plot of pooled effect size for the risk of fracture at any site in A) postmenopausal women, B) premenopausal women, and C) men with vs. without obesity, using a random-effect model.
Fig 3
Fig 3
Forest plot of pooled effect size for the risk of hip fracture in A) postmenopausal women and B) men with vs. without obesity, using a random-effect model.
Fig 4
Fig 4
Forest plot of pooled effect size for the total hip aBMD by DXA mean difference between A) postmenopausal women, B) premenopausal women and C) men with vs. without obesity, using a random-effect model.
See this image and copyright information in PMC

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