Lin Yu-Hsiang, Yip Hei-Tung, Lin Jung-Ju, Tu Cheng-Hao, Tsai Chun-Hao, Chen XianXiu, Chen Der-Cherng
Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Med Sci Monit. 2025 May 24;31:e947660. doi: 10.12659/MSM.947660.
BACKGROUND Osteoporotic fractures are a significant public health problem, yet traditional risk assessment methods have limitations. This retrospective study used the integrated Healthcare information (iHi) Data Platform of China Medical University Hospital (CMUH) (2000-2020) to evaluate associations between body mass index (BMI), bone mineral density (BMD), body fat percentage (BFP), basal metabolic rate (BMR), and site-specific fracture risk in 9583 Taiwanese individuals. MATERIAL AND METHODS We extracted DXA-measured BMD, BMI, BFP, and BMR data from CMUH's iHi Platform. Fracture events were identified using ICD-9/10 codes and verified through radiology reports. Cox proportional hazards regression models estimated fracture risk, adjusting for demographic and clinical factors. Mediation analysis quantified the contributions of BFP and BMR to the BMI-fracture relationship. RESULTS During median follow-up of 8.7 years, 1672 fractures (17.4%) occurred. Individuals with normal BMD showed an 82% lower fracture risk compared to those with osteoporosis (adjusted hazard ratio [aHR]=0.18, 95% CI: 0.15-0.22, p<0.001). Normal BFP significantly reduced fracture risk by 77% versus low BFP (aHR=0.23, 95% CI: 0.07-0.72, p=0.012). Higher BMR was consistently protective, with aHR=0.54 (95% CI: 0.36-0.82, p=0.004) for BMR ≥1500 versus BMR<1000. While underweight increased fracture risk (aHR=1.75, 95% CI: 1.29-2.36, p<0.001), obesity conferred no significant protection (aHR=1.04, 95% CI: 0.89-1.21, p=0.58). CONCLUSIONS This study demonstrates that fracture risk assessment should incorporate BFP and BMR alongside BMD and BMI. The "BMI paradox" was explained through mediation analysis, revealing BFP and BMR as critical intermediaries accounting for 50% and 32% of the BMI-fracture relationship, respectively. These findings support developing ethnicity-specific fracture risk models integrating body composition metrics for more precise risk stratification.
骨质疏松性骨折是一个重大的公共卫生问题，但传统的风险评估方法存在局限性。这项回顾性研究利用中国医科大学附设医院（CMUH）的整合医疗信息（iHi）数据平台（2000 - 2020年），评估了9583名台湾个体的体重指数（BMI）、骨密度（BMD）、体脂百分比（BFP）、基础代谢率（BMR）与特定部位骨折风险之间的关联。
我们从CMUH的iHi平台提取了双能X线吸收法（DXA）测量的BMD、BMI、BFP和BMR数据。使用国际疾病分类第九版/第十版（ICD - 9/10）编码识别骨折事件，并通过放射学报告进行验证。Cox比例风险回归模型估计骨折风险，并对人口统计学和临床因素进行调整。中介分析量化了BFP和BMR对BMI与骨折关系的贡献。
在中位随访8.7年期间，发生了1672例骨折（17.4%）。骨密度正常的个体与骨质疏松个体相比，骨折风险降低了82%（调整后风险比[aHR]=0.18，95%置信区间[CI]：0.15 - 0.22，p<0.001）。正常的体脂百分比与低体脂百分比相比，显著降低骨折风险77%（aHR=0.23，95% CI：0.07 - 0.72，p=0.012）。较高的基础代谢率始终具有保护作用，基础代谢率≥1500者与基础代谢率<1000者相比，aHR=0.54（95% CI：0.36 - 0.82，p=0.004）。虽然体重过轻会增加骨折风险（aHR=1.75，95% CI：1.29 - 2.36，p<0.001），但肥胖并没有显著的保护作用（aHR=1.04，95% CI：0.89 - 1.21，p=0.58）。
本研究表明，骨折风险评估应将体脂百分比和基础代谢率与骨密度和体重指数一起纳入。通过中介分析解释了“BMI悖论”，揭示体脂百分比和基础代谢率分别是BMI与骨折关系的关键中介因素，分别占50%和32%。这些发现支持开发整合身体成分指标的特定种族骨折风险模型，以进行更精确的风险分层。
