General and abdominal obesity operate differently as influencing factors of fracture risk in old adults.

To infer the causality between obesity and fracture and the difference between general and abdominal obesity, a prospective study was performed in 456,921 participants, and 10,142 participants developed an incident fracture with follow-up period of 7.96 years. A U-shape relationship was observed between BMI and fracture, with the lowest risk of fracture in overweight participants. The obesity individuals had higher fracture risk when BMD was adjusted, and the protective effect of moderate-high BMI on fracture was mostly mediated by bone mineral density (BMD). However, for abdominal obesity, the higher WCadjBMI (linear) and HCadjBMI (J-shape) were found to be related to higher fracture risk, and less than 30% of the effect was mediated by BMD. By leveraging genetic instrumental variables, it provided additional evidences to support the aforementioned findings. In conclusion, keeping moderate-high BMI might be of benefit to old people in terms of fracture risk, whereas abdominal adiposity might increase risk of fracture.