Body mass index and subsequent fracture risk: A meta-analysis to update FRAX®

Nicholas C Harvey^{1

2}, Helena Johansson³, Eugene V McCloskey^{3

4}, Enwu Liu⁵, Kristina E Åkesson^{6

7}, Fred A Anderson⁸, Rafael Azagra-Ledesma^{9

10

11

12}, Cecilie L Bager¹³, Charlotte Beaudart¹⁴, Heike A Bischoff-Ferrari^{15

16}, Emmanuel Biver¹⁷, Olivier Bruyère¹⁸, Jane A Cauley¹⁹, Jacqueline R Center^{20

21}, Roland Chapurlat²², Claus Christiansen¹³, Cyrus Cooper^{1

2

23}, Carolyn J Crandall²⁴, Steven R Cummings²⁵, José A P da Silva^{26

27}, Bess Dawson-Hughes²⁸, Adolfo Diez-Perez²⁹, Alyssa B Dufour^{30

31}, John A Eisman^{21

32

33}, Petra J M Elders³⁴, Serge Ferrari¹⁷, Yuki Fujita³⁵, Saeko Fujiwara³⁶, Claus-Christian Glüer³⁷, Inbal Goldshtein^{38

39}, David Goltzman⁴⁰, Vilmundur Gudnason^{41

42}, Jill Hall⁴³, Didier Hans⁴⁴, Mari Hoff^{45

46}, Rosemary J Hollick⁴⁷, Martijn Huisman^{48

49}, Masayuki Iki⁵⁰, Sophia Ish-Shalom⁵¹, Graeme Jones⁵², Magnus K Karlsson^{6

53}, Sundeep Khosla⁵⁴, Douglas P Kiel^{31

55}, Woon-Puay Koh^{56

57}, Fjorda Koromani^{58

59}, Mark A Kotowicz^{60

61

62}, Heikki Kröger^{63

64}, Timothy Kwok^{65

66}, Olivier Lamy^{67

68}, Arnulf Langhammer^{69

70}, Bagher Larijani⁷¹, Kurt Lippuner⁷², Fiona E A McGuigan⁶, Dan Mellström^{73

74}, Thomas Merlijn³⁴, Tuan V Nguyen^{75

76

77}, Anna Nordström^{78

79

80}, Peter Nordström⁸¹, Terence W O'Neill^{82

83}, Barbara Obermayer-Pietsch⁸⁴, Claes Ohlsson^{85

86}, Eric S Orwoll⁸⁷, Julie A Pasco^{88

89

90

91}, Fernando Rivadeneira⁵⁸, Berit Schei^{92

93}, Anne-Marie Schott⁹⁴, Eric J Shiroma⁹⁵, Kristin Siggeirsdottir^{41

96}, Eleanor M Simonsick⁹⁷, Elisabeth Sornay-Rendu⁹⁸, Reijo Sund⁶⁴, Karin M A Swart^{99

100}, Pawel Szulc⁹⁸, Junko Tamaki¹⁰¹, David J Torgerson¹⁰², Natasja M van Schoor^{103

104}, Tjeerd P van Staa¹⁰⁵, Joan Vila¹⁰⁶, Nicholas J Wareham¹⁰⁷, Nicole C Wright¹⁰⁸, Noriko Yoshimura¹⁰⁹, M Carola Zillikens⁵⁸, Marta Zwart^{12

110

111

112}, Liesbeth Vandenput⁸⁵, Mattias Lorentzon^{113

114}, William D Leslie¹¹⁵, John A Kanis³

Affiliations

¹ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
² NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
³ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.
⁴ MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, United Kingdom.
⁵ South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
⁶ Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁷ Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
⁸ GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States.
⁹ Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹⁰ Docencia Atenció Primària, Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.
¹¹ GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹² PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain.
¹³ Nordic Bioscience A/S, Herlev, Denmark.
¹⁴ Public Health Aging Research & Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), NAmur Research Institute for LIfe Sciences (NARILIS), Faculty of Medicine, University of Namur.
¹⁵ University of Basel, Dept. of Aging Medicine, FELIX PLATTER, Switzerland.
¹⁶ Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland.
¹⁷ Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁸ Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁹ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, United States.
²⁰ Garvan Institute of Medical Research, Sydney, NSW, Australia.
²¹ St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia.
²² INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
²³ NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, United Kingdom.
²⁴ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
²⁵ San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States.
²⁶ Centre for Innovative Biomedicine and Biotechnology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁷ Rheumatology Department, University Hospital and University of Coimbra, Portugal.
²⁸ Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States.
²⁹ Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
³⁰ Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.
³¹ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
³² Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
³³ School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
³⁴ Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁵ Department of Hygiene and Public Health, Faculty of Medicine, Kansai Medical University, Osaka, Japan.
³⁶ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
³⁷ Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
³⁸ Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
³⁹ Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴⁰ Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
⁴¹ Icelandic Heart Association, Kopavogur, Iceland.
⁴² University of Iceland, Reykjavik, Iceland.
⁴³ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
⁴⁴ Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
⁴⁵ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
⁴⁶ Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
⁴⁷ Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom.
⁴⁸ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
⁴⁹ Department of Sociology, VU University, Amsterdam, The Netherlands.
⁵⁰ Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.
⁵¹ Endocrine Clinic, Elisha Hospital, Haifa, Israel.
⁵² Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵³ Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
⁵⁴ Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States.
⁵⁵ Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, United States.
⁵⁶ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore.
⁵⁷ Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore.
⁵⁸ Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁹ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶⁰ Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, Victoria, Australia.
⁶¹ Barwon Health, Geelong, Victoria, Australia.
⁶² Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia.
⁶³ Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
⁶⁴ Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
⁶⁵ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁶⁶ Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁶⁷ Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁸ Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁹ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁷⁰ Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
⁷¹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷² ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland.
⁷³ Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷⁴ Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden.
⁷⁵ School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.
⁷⁶ School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.
⁷⁷ Tam Anh Research Institute, Tam Anh Hospital, Ho Chi Minh City, Vietnam.
⁷⁸ School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷⁹ Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden.
⁸⁰ Department of Medical Sciences, Uppsala University, Sweden.
⁸¹ Department of public health and caring sciences, Uppsala University, Uppsala, Sweden.
⁸² National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
⁸³ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.
⁸⁴ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.
⁸⁵ Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸⁶ Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁸⁷ Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States.
⁸⁸ Deakin University, Institute for Physical and Mental Health and Clinical Translation (IMPACT), Geelong, Australia.
⁸⁹ Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.
⁹⁰ Barwon Health, Geelong, Australia.
⁹¹ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁹² Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
⁹³ Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim, Norway.
⁹⁴ Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
⁹⁵ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, United States.
⁹⁶ Janus Rehabilitation, Reykjavik, Iceland.
⁹⁷ Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, Maryland.
⁹⁸ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
⁹⁹ Department of General Practice, Amsterdam UMC, location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹⁰⁰ PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
¹⁰¹ Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
¹⁰² York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom.
¹⁰³ Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, Amsterdam, Netherlands.
¹⁰⁴ Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands.
¹⁰⁵ Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
¹⁰⁶ Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
¹⁰⁷ MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
¹⁰⁸ Center for Health Outcomes, Implementation, and Community-Engaged Sciences, Tulane University, New Orleans, LA, United States.
¹⁰⁹ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
¹¹⁰ Health Center Can Gibert del Pla, Catalan Institute of Health, Girona, Spain.
¹¹¹ Department of Medical Sciences, University of Girona, Girona, Spain.
¹¹² GROICAP (research group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹¹³ Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Sweden.
¹¹⁴ Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
¹¹⁵ Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

PMID: 40795319
DOI: 10.1093/jbmr/zjaf091

Free article

Body mass index and subsequent fracture risk: A meta-analysis to update FRAX®

Nicholas C Harvey et al. J Bone Miner Res. 2025.

Free article

. 2025 Aug 8:zjaf091.

doi: 10.1093/jbmr/zjaf091. Online ahead of print.

Authors

Affiliations

¹ MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom.
² NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
³ Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.
⁴ MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, United Kingdom.
⁵ South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
⁶ Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.
⁷ Department of Orthopedics, Skåne University Hospital, Malmö, Sweden.
⁸ GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States.
⁹ Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹⁰ Docencia Atenció Primària, Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain.
¹¹ GROIMAP/GROICAP (research groups), Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹² PRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain.
¹³ Nordic Bioscience A/S, Herlev, Denmark.
¹⁴ Public Health Aging Research & Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), NAmur Research Institute for LIfe Sciences (NARILIS), Faculty of Medicine, University of Namur.
¹⁵ University of Basel, Dept. of Aging Medicine, FELIX PLATTER, Switzerland.
¹⁶ Centre on Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland.
¹⁷ Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
¹⁸ Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
¹⁹ Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, United States.
²⁰ Garvan Institute of Medical Research, Sydney, NSW, Australia.
²¹ St Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia.
²² INSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
²³ NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, United Kingdom.
²⁴ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.
²⁵ San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States.
²⁶ Centre for Innovative Biomedicine and Biotechnology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
²⁷ Rheumatology Department, University Hospital and University of Coimbra, Portugal.
²⁸ Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States.
²⁹ Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
³⁰ Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.
³¹ Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
³² Skeletal Diseases Program, Garvan Institute of Medical Research, Sydney, NSW, Australia.
³³ School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia.
³⁴ Department of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³⁵ Department of Hygiene and Public Health, Faculty of Medicine, Kansai Medical University, Osaka, Japan.
³⁶ Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
³⁷ Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
³⁸ Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
³⁹ Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁴⁰ Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
⁴¹ Icelandic Heart Association, Kopavogur, Iceland.
⁴² University of Iceland, Reykjavik, Iceland.
⁴³ MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
⁴⁴ Interdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) & University of Lausanne, Lausanne, Switzerland.
⁴⁵ Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
⁴⁶ Department of Rheumatology, St Olavs Hospital, Trondheim, Norway.
⁴⁷ Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom.
⁴⁸ Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
⁴⁹ Department of Sociology, VU University, Amsterdam, The Netherlands.
⁵⁰ Department of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.
⁵¹ Endocrine Clinic, Elisha Hospital, Haifa, Israel.
⁵² Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵³ Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden.
⁵⁴ Robert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States.
⁵⁵ Marcus Institute for Aging Research, Hebrew Senior Life, Boston, MA, United States.
⁵⁶ Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore.
⁵⁷ Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore.
⁵⁸ Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁵⁹ Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶⁰ Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, Victoria, Australia.
⁶¹ Barwon Health, Geelong, Victoria, Australia.
⁶² Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia.
⁶³ Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
⁶⁴ Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
⁶⁵ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁶⁶ Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
⁶⁷ Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁸ Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
⁶⁹ HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁷⁰ Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
⁷¹ Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
⁷² ARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland.
⁷³ Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷⁴ Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden.
⁷⁵ School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia.
⁷⁶ School of Population Health, UNSW Medicine, UNSW Sydney, Kensington, Australia.
⁷⁷ Tam Anh Research Institute, Tam Anh Hospital, Ho Chi Minh City, Vietnam.
⁷⁸ School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷⁹ Department of Health Sciences, Swedish Winter Sports Research Centre, Mid Sweden University, Östersund, Sweden.
⁸⁰ Department of Medical Sciences, Uppsala University, Sweden.
⁸¹ Department of public health and caring sciences, Uppsala University, Uppsala, Sweden.
⁸² National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
⁸³ Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom.
⁸⁴ Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria.
⁸⁵ Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁸⁶ Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
⁸⁷ Department of Medicine, Oregon Health & Science University, Portland, Oregon, United States.
⁸⁸ Deakin University, Institute for Physical and Mental Health and Clinical Translation (IMPACT), Geelong, Australia.
⁸⁹ Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia.
⁹⁰ Barwon Health, Geelong, Australia.
⁹¹ Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
⁹² Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
⁹³ Department of Obstetrics and Gynaecology, St Olavs Hospital, Trondheim, Norway.
⁹⁴ Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France.
⁹⁵ Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, Maryland, United States.
⁹⁶ Janus Rehabilitation, Reykjavik, Iceland.
⁹⁷ Translational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, Maryland.
⁹⁸ INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
⁹⁹ Department of General Practice, Amsterdam UMC, location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
¹⁰⁰ PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
¹⁰¹ Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.
¹⁰² York Trials Unit, Department of Health Sciences, University of York, York, United Kingdom.
¹⁰³ Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, Amsterdam, Netherlands.
¹⁰⁴ Amsterdam Public Health Research Institute, Aging & Later Life, Amsterdam, The Netherlands.
¹⁰⁵ Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
¹⁰⁶ Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
¹⁰⁷ MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
¹⁰⁸ Center for Health Outcomes, Implementation, and Community-Engaged Sciences, Tulane University, New Orleans, LA, United States.
¹⁰⁹ Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
¹¹⁰ Health Center Can Gibert del Pla, Catalan Institute of Health, Girona, Spain.
¹¹¹ Department of Medical Sciences, University of Girona, Girona, Spain.
¹¹² GROICAP (research group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Girona, Spain.
¹¹³ Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Sweden.
¹¹⁴ Region Västra Götaland, Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
¹¹⁵ Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

PMID: 40795319
DOI: 10.1093/jbmr/zjaf091

Abstract

The aim of this international meta-analysis was to quantify the predictive value of body mass index (BMI) for incident fracture and relationship of this risk with age, sex, follow-up time and bone mineral density (BMD). 1 667 922 men and women from 32 countries (63 cohorts), followed for a total of 16.0 million person-years were studied. 293 325 had femoral neck BMD measured (2.2 million person-years follow-up). An extended Poisson model in each cohort was used to investigate relationships between WHO-defined BMI categories (Underweight:<18.5 kg/m2; Normal:18.5-24.9 kg/m2; Overweight:25.0-29.9 kg/m2; Obese I:30.0-34.9 kg/m2; Obese II:≥35.0 kg/m2) and risk of incident osteoporotic, major osteoporotic and hip fracture (HF). Inverse-variance weighted β-coefficients were used to merge the cohort-specific results. For the subset with BMD available, in models adjusted for age and follow-up time, the hazard ratio (95%CI) for HF comparing underweight with normal weight was 2.35 (2.10-2.60) in women and for men was 2.45 (1.90-3.17). HF risk was lower in overweight and obese categories compared to normal weight [obese II vs normal: women 0.66 (0.55-0.80); men 0.91 (0.66-1.26). Further adjustment for femoral neck BMD T-score attenuated the increased risk associated with underweight [underweight vs normal: women 1.69 (1.47-1.96); men 1.46 (1.00-2.13)]. In these models, the protective effects of overweight and obesity were attenuated, and in both sexes the direction of association reversed to higher fracture risk in Obese II category [Obese II vs Normal: women 1.24 (0.97-1.58); men 1.70 (1.06-2.75)]. Results were similar for other fracture outcomes. Underweight is a risk factor for fracture in both men and women regardless of adjustment for BMD. However, whilst overweight/obesity appeared protective base models, they became risk factors after additional adjustment for femoral neck BMD, particularly in the Obese II category. This effect in the highest BMI categories was of greater magnitude in men than women. These results will inform the second iteration of FRAX.

Keywords: FRAX; body mass index; epidemiology; hip fracture; major osteoporotic fracture; meta-analysis; osteoporosis.

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Body mass index and subsequent fracture risk: A meta-analysis to update FRAX®

Affiliations

Body mass index and subsequent fracture risk: A meta-analysis to update FRAX®

Authors

Affiliations

Abstract

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