Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Osteoporos Int. 2018 Jan;29(1):31-39. doi: 10.1007/s00198-017-4294-7. Epub 2017 Nov 3.
We conducted a meta-analysis of prospective studies to assess the association between BMI and incident vertebral fracture. We found that as body mass index (BMI) increases, the risk of vertebral fracture decreases in men, but not in women, suggesting possible gender differences in the relationship of BMI with risk of vertebral fracture.
Recent evidence suggests that the relationship between BMI and fracture risk may be site-specific. We conducted a systematic review and meta-analysis of prospective studies to investigate the association between BMI and risk of incident vertebral fracture.
PubMed and Embase were searched for relevant articles published from inception through February 15, 2017. Extracted relative risks (RR) from the prospective studies were pooled using random-effects meta-analysis.
Six studies were included, with a total of 105,129 participants followed for 3 to 19 years. The pooled RR (95% confidence interval [CI]) for vertebral fracture per each standard deviation increase in BMI was 0.94 (95% CI = 0.80-1.10) with significant heterogeneity (I = 88.0%, p < 0.001). In subgroup analysis by gender, we found a significant inverse association between BMI and risk of vertebral fracture in men (RR = 0.85, 95% CI = 0.73-0.98, n = 25,617 participants) but not in women (RR = 0.98, 95% CI = 0.81-1.20, n = 79,512 participants). Across studies of women not adjusting for bone mineral density (BMD), there was no significant association between BMI and risk of vertebral fracture (RR = 0.91, 95% CI = 0.80-1.04, p = 0.18, n = 72,755 participants). However, BMI was associated with an increased risk of vertebral fracture in studies of women that adjusted for BMD (RR = 1.28, 95% CI = 1.17-1.40, p < 0.001, n = 6757 participants). Substantial heterogeneity was found among studies of women (I = 90.1%, p < 0.001), which was partly explained by the adjustment for BMD (adjusted R = 61%). We found no evidence of publication bias (p = 0.40).
In conclusion, our findings suggest that there might be gender differences in the relationship of BMI with risk of vertebral fracture. Further research is needed, including the assessment of other measures of adiposity, such as visceral adiposity, on the risk of vertebral fracture.
我们进行了一项荟萃分析，以评估 BMI 与新发椎体骨折之间的关系。我们发现，随着体重指数（BMI）的增加，男性椎体骨折的风险降低，但女性则不然，这表明 BMI 与椎体骨折风险之间的关系可能存在性别差异。
最近的证据表明，BMI 与骨折风险之间的关系可能具有特定部位的特点。我们进行了一项系统评价和荟萃分析，以研究 BMI 与新发椎体骨折风险之间的关系。
通过检索 PubMed 和 Embase 数据库，我们从数据库建立开始到 2017 年 2 月 15 日收集了前瞻性研究的相关文章。使用随机效应荟萃分析，从前瞻性研究中提取相对风险（RR）。
纳入了 6 项研究，共有 105129 名参与者随访 3 至 19 年。BMI 每增加一个标准差，椎体骨折的 RR（95%置信区间[CI]）为 0.94（95% CI=0.80-1.10），存在显著的异质性（I=88.0%，p<0.001）。按性别进行亚组分析时，我们发现 BMI 与男性椎体骨折风险之间存在显著的负相关（RR=0.85，95% CI=0.73-0.98，n=25617 名参与者），但在女性中则不然（RR=0.98，95% CI=0.81-1.20，n=79512 名参与者）。在未调整骨密度（BMD）的女性研究中，BMI 与椎体骨折风险之间无显著关联（RR=0.91，95% CI=0.80-1.04，p=0.18，n=72755 名参与者）。然而，在调整了 BMD 的女性研究中，BMI 与椎体骨折风险增加相关（RR=1.28，95% CI=1.17-1.40，p<0.001，n=6757 名参与者）。在女性研究中存在很大的异质性（I=90.1%，p<0.001），部分原因是调整了 BMD（调整后的 R=61%）。我们没有发现发表偏倚的证据（p=0.40）。
总之，我们的研究结果表明，BMI 与椎体骨折风险之间的关系可能存在性别差异。需要进一步的研究，包括评估其他肥胖指标，如内脏脂肪，对椎体骨折风险的影响。
