Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
J Bone Miner Res. 2010 Feb;25(2):292-7. doi: 10.1359/jbmr.091004.
Low body mass index (BMI) is a recognized risk factor for fragility fracture, whereas obesity is widely believed to be protective. As part of a clinical audit of guidance from the National Institute of Health and Clinical Excellence (NICE), we have documented the prevalence of obesity and morbid obesity in postmenopausal women younger than 75 years of age presenting to our Fracture Liaison Service (FLS). Between January 2006 and December 2007, 1005 postmenopausal women aged less than 75 years with a low-trauma fracture were seen in the FLS. Of these women, 805 (80%) underwent assessment of bone mineral density (BMD) by dual energy X-ray absorptiometry (DXA), and values for BMI were available in 799. The prevalence of obesity (BMI 30 to 34.9 kg/m(2)) and morbid obesity (BMI > or = 35 kg/m(2)) in this cohort was 19.3% and 8.4%, respectively. Normal BMD was reported in 59.1% of obese and 73.1% of morbidly obese women, and only 11.7% and 4.5%, respectively, had osteoporosis (p < .0001). Multiple regression analysis revealed significant negative associations between hip T-score and age (p < .0001) and significant positive associations with BMI (p < .0001) and previous fracture (p = .001). Our results demonstrate a surprisingly high prevalence of obesity in postmenopausal women presenting to the FLS with low-trauma fracture. Most of these women had normal BMD, as measured by DXA. Our findings have important public heath implications in view of the rapidly rising increase in obesity in many populations and emphasize the need for further studies to establish the pathogenesis of fractures in obese individuals and to determine appropriate preventive strategies.
体重指数（BMI）低是脆性骨折的公认危险因素，而肥胖则被广泛认为具有保护作用。作为对英国国家卫生与临床优化研究所（NICE）指南进行临床审核的一部分，我们记录了就诊于骨折联络服务（FLS）的绝经后年龄<75 岁女性中肥胖和病态肥胖的流行情况。2006 年 1 月至 2007 年 12 月，FLS 共接诊了 1005 例年龄<75 岁、因低创伤性骨折就诊的绝经后女性。这些女性中，805 例（80%）接受了双能 X 线吸收法（DXA）骨密度评估，其中 799 例有 BMI 值。该队列中肥胖（BMI 30-34.9kg/m2）和病态肥胖（BMI≥35kg/m2）的患病率分别为 19.3%和 8.4%。肥胖女性的正常 BMD 占 59.1%，病态肥胖女性的正常 BMD 占 73.1%，而骨质疏松的比例分别为 11.7%和 4.5%（p<0.0001）。多元回归分析显示，髋 T 评分与年龄呈显著负相关（p<0.0001），与 BMI（p<0.0001）和既往骨折（p=0.001）呈显著正相关。我们的研究结果表明，就诊于 FLS 的低创伤性骨折绝经后女性肥胖的患病率令人惊讶地高。这些女性中，大多数的 DXA 测量的 BMD 正常。鉴于许多人群肥胖率迅速上升，我们的研究结果具有重要的公共卫生意义，强调需要进一步研究来确定肥胖个体骨折的发病机制，并制定适当的预防策略。
