Obesity is not protective against fracture in postmenopausal women: GLOW.
Obesity is not protective against fracture in postmenopausal women: GLOW.
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DOI：
10.1016/j.amjmed.2011.06.013
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发表时间：
2011-11
期刊：
影响因子：
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通讯作者：
Glow Investigators
中科院分区：
文献类型：
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作者：
Compston JE;Watts NB;Chapurlat R;Cooper C;Boonen S;Greenspan S;Pfeilschifter J;Silverman S;Díez-Pérez A;Lindsay R;Saag KG;Netelenbos JC;Gehlbach S;Hooven FH;Flahive J;Adachi JD;Rossini M;Lacroix AZ;Roux C;Sambrook PN;Siris ES;Glow Investigators
研究入选全球女性骨质疏松纵向研究（GLOW）的绝经后肥胖女性临床骨折的患病率和发生率。这是一项多国、前瞻性、观察性、基于人群的研究，由10个国家17个研究中心的723名医生进行。共纳入60，393例年龄≥55岁的女性。数据收集使用自我管理的问卷调查，涵盖领域，包括病人的特点，骨折史，骨折的危险因素，抗骨质疏松症药物。在基线、1年和2年时，获得了44，534名女性的体重指数（BMI）和骨折史，其中23.4%为肥胖（BMI ≥30 kg/m2）。基线时肥胖女性的骨折患病率为222/1000，2年时的发病率为61.7/1000，与非肥胖女性的发病率相似（分别为227/1000和66.0/1000）。肥胖女性的骨折分别占所有既往骨折和新发骨折的23%和22%。肥胖女性发生踝关节和大腿骨折的风险明显高于非肥胖女性，而手腕骨折的风险明显低于非肥胖女性。骨折的肥胖女性更有可能经历过早期绝经，并报告在过去一年中有两次或两次以上的福尔斯跌倒。自报哮喘、肺气肿和1型糖尿病在发生骨折的肥胖女性中比非肥胖女性更常见。在2年时，27%的肥胖女性发生骨折正在接受骨保护治疗，而非肥胖女性为41%，体重不足女性为57%。我们的研究结果表明，肥胖对绝经后妇女的骨折没有保护作用，并且与踝关节和大腿骨折的风险增加有关。鉴于肥胖症发病率的迅速上升，这些发现具有重大的公共卫生意义。需要进一步的研究来确定肥胖人群骨折的发病机制，并制定有效的预防策略。
To investigate the prevalence and incidence of clinical fractures in obese, postmenopausal women enrolled in the Global Longitudinal study of Osteoporosis in Women (GLOW). This was a multinational, prospective, observational, population-based study carried out by 723 physician practices at 17 sites in 10 countries. A total of 60,393 women aged ≥55 years were included. Data were collected using self-administered questionnaires that covered domains that included patient characteristics, fracture history, risk factors for fracture, and anti-osteoporosis medications. Body mass index (BMI) and fracture history were available at baseline, 1 and 2 years in 44,534 women, 23.4% of whom were obese (BMI ≥30 kg/m2). Fracture prevalence in obese women at baseline was 222 per 1,000 and incidence at 2 years was 61.7 per 1,000, similar to rates in non-obese women (227 and 66.0 per 1,000, respectively). Fractures in obese women accounted for 23% and 22% of all previous and incident fractures, respectively. The risk of incident ankle and upper leg fractures was significantly higher in obese than in non-obese women whilst the risk of wrist fracture was significantly lower. Obese women with fracture were more likely to have experienced early menopause and to report two or more falls in the past year. Self-reported asthma, emphysema, and type 1 diabetes were all significantly more common in obese than non-obese women with incident fracture. At 2 years, 27% of obese women with incident fracture were receiving bone-protective therapy, compared with 41% of non-obese and 57% of underweight women. Our results demonstrate that obesity is not protective against fracture in postmenopausal women and is associated with increased risk of ankle and upper leg fractures. These findings have major public health implications in view of the rapidly rising incidence of obesity. Further studies are required to establish the pathogenesis of fractures in the obese population and to develop effective preventive strategies.