In postmenopausal women, both weight gain and weight loss are linked to increased incidence of fracture, but not at the same body sites, according to recently published data.

In the study published in The BMJ, researchers evaluated data from more than 120,000 healthy postmenopausal women aged 50 to 79 years (mean age, 63.3 years) from the Women’s Health Observational Study and Clinical Trials.

Participants were weighed annually and asked to report upper limb fractures, including those of the hand, wrist, elbow, upper arm and shoulder; lower limb fractures, including those of the foot, knee, upper leg and ankle; and central body fractures, including those of the hip, pelvis and spine.


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After an average follow-up of 11 years, 65.6% of participants had stable weight; 15.2% lost weight; and 19.0% gained weight, according to the study results.

The researchers found a link between weight loss and a 65% increase in hip fractures (adjusted HR=1.65; 95% CI, 1.49-1.82), a 9% increase in upper limb fractures (adjusted HR=1.09; 95% CI, 1.03-1.16) and a 30% increase in central body fractures (adjusted HR=1.30; 95% CI, 1.20-1.39), as compared with stable weight.

Similarly, results associated weight gain with a 10% increase in upper limb fractures (1.10; 95% CI, 1.05-1.18) and an 18% increase in lower limb fractures (adjusted HR=1.18; 95% CI, 1.12-1.25), as compared with stable weight.

Further, unintentional weight loss was linked to a 33% increase in hip fractures (adjusted HR=1.33; 95% CI, 1.19-1.47) and a 16% increase in vertebral fractures (adjusted HR=1.16; 95% CI, 1.06-1.26), while intentional weight loss was associated with an 11% increase in lower limb fractures (adjusted HR=1.11; 95% CI, 1.05-1.17), but a decrease in hip fractures (adjusted HR=0.85; 95% CI, 0.76-0.95).

“These findings have clinical research implications and challenge the traditional clinical paradigm of weight gain protecting against fractures,” the researchers concluded. “Clinicians should be aware that even intentional weight loss is associated with increased rates of lower limb fractures. Weight loss intervention trials should consider potential effects on the incidence of fracture.”

In an accompanying editorial, Juliet Compston, MD, FRCP, FRCPath, FMedSci, Emeritus Professor of Bone Medicine at the Cambridge Biomedical Campus in the United Kingdom, discussed the clinical implications of the study’s findings.

“In those who are overweight or obese, the many health benefits associated with weight loss are likely to outweigh any adverse skeletal effects. Likewise, for those who gain sufficient weight to become overweight or obese, weight loss should be advised on general health grounds,” Dr. Compston wrote.

“The finding of an increase in risk of fracture with intentional weight loss and with weight gain, albeit small, however, emphasizes the need for measures to prevent bone loss during interventions to reduce weight.”

References

  1. Crandall CJ et al. BMJ. 2015;doi:10.1136/bmj.h25.
  2. Compston J. BMJ. 2015;doi:10.1136/bmj.h60.