Association between abdominal obesity and fragility fractures among elderly Israeli women
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ORIGINAL ARTICLE
Association between abdominal obesity and fragility fractures among elderly Israeli women Orit Ofir1 · Assaf Buch1,2,3 · Vanessa Rouach2 · Rebecca Goldsmith4 · Naftali Stern2,3 · Efrat Monsonego‑Ornan1 Received: 24 May 2019 / Accepted: 3 September 2019 © Springer Nature Switzerland AG 2019
Abstract Background Obesity has been traditionally viewed as a protective factor for fractures. Recent studies have challenged this concept, particularly regarding abdominal obesity. We aimed to investigate the association between abdominal obesity, body mass index (BMI) and fragility fractures prevalence in a sample of community-dwelling elderly Israeli women. Methods The data in this cross-sectional study were based on ‘Mabat Zahav’—a survey of a nationally representative sample of elderly Israelis. The study population included 669 women. Data on fragility fractures site and circumstances were selfreported, and height, weight, waist and calf circumferences were measured. Waist circumference (WC) variable was divided into tertiles: 99 cm. Results Sixty-five women reported fragility fractures (14 hip fractures, 18 vertebral fractures and 39 wrist fractures). Mean age was 73.9 ± 5.9 years, mean BMI was 29.9 ± 5 kg/m2 and mean WC was 93.9 ± 12 cm. While BMI was not associated with osteoporotic fractures, abdominal obesity (WC > 88 cm) was positively associated with fragility fractures, independently of age, smoking, physical activity [middle and high WC tertiles {3.15 (95% CI 1.41–7.02), 2.78 (95% CI 1.05–7.31), respectively}]. Conclusions Among this sample of elderly women, abdominal obesity was positively associated with fragility fractures, independently of age, smoking, physical activity and BMI. Waist circumference, an easily measured anthropometric indicator, may be useful for assessing the risk of fragility fractures in elderly women, particularly among those with normal or high BMI—a vast population which has been traditionally considered as having lower fracture risk. Keywords Osteoporosis · Fragility fractures · Abdominal obesity · Waist circumference · BMI
Introduction
Orit Ofir and Assaf Buch contributed equally to this work. * Orit Ofir [email protected] 1
Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O.B 12, 76100 Rehovot, Israel
2
Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239 Tel‑Aviv, Israel
3
The Sackler Faculty of Medicine, Tel-Aviv University, Dr Ya’ackov Klachkin 35 St, 6997801 Tel‑Aviv, Israel
4
Nutrition Division, Ministry of Health Israel, Yirmiyahu 39 St, Jerusalem, Israel
The prevalence of osteoporotic fractures and obesity is increasing among older people in Western countries. Worldwide, 1 in 3 women and 1 in 5 men over the age 50 experience osteoporotic fractures [1] and 19.5% of the Organisation for Economic Co-operation and Development (OECD) countries’ adult population is obese [2]. With the increase in life expectancy, the contribution
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