Divergent effects of obesity on fragility fractures.
Divergent effects of obesity on fragility fractures.
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DOI：
10.2147/cia.s64625
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发表时间：
2014
影响因子：
3.6
通讯作者：
Gonnelli S
中科院分区：
文献类型：
--
作者：
Caffarelli C;Alessi C;Nuti R;Gonnelli S
肥胖通常被认为有利于保持骨骼健康，因为超重的人观察到更高的骨密度。然而，最近的几项研究挑战了人们普遍认为肥胖对骨折具有保护作用的信念，并表明肥胖是某些骨折的风险因素。肥胖对骨折风险的影响是部位相关的，一些骨折(肱骨、脚踝、上臂)的风险增加，而其他骨折(髋骨、骨盆、手腕)的风险降低。此外，肥胖和骨折之间的关系也可能因性别、年龄和种族而异。肥胖者骨折的危险因素似乎与非肥胖者相似，尽管下降的模式在肥胖者中尤其重要。需要研究来确定肥胖的内脏脂肪和代谢并发症(2型糖尿病、胰岛素抵抗、慢性炎症等)是否以及如何与骨骼状况和脆性骨折风险之间存在因果关系。维生素D缺乏和性腺机能减退也可能影响肥胖者的骨折风险。FRAX®等断裂算法可能会低估断裂概率。目前还没有专门为评估不同药物在肥胖患者中的抗骨折效果而设计的研究；然而，文献数据可能表明，在肥胖患者中，可能需要更高剂量的双膦酸类药物才能维持对非椎体骨折的疗效。因此，在日益增长的成人和老年肥胖者中寻找更好的方法来识别脆性骨折风险可能被认为是一个临床优先事项，可以改善肥胖者骨折的预防。
Obesity was commonly thought to be advantageous for maintaining healthy bones due to the higher bone mineral density observed in overweight individuals. However, several recent studies have challenged the widespread belief that obesity is protective against fracture and have suggested that obesity is a risk factor for certain fractures. The effect of obesity on fracture risk is site-dependent, the risk being increased for some fractures (humerus, ankle, upper arm) and decreased for others (hip, pelvis, wrist). Moreover, the relationship between obesity and fracture may also vary by sex, age, and ethnicity. Risk factors for fracture in obese individuals appear to be similar to those in nonobese populations, although patterns of falling are particularly important in the obese. Research is needed to determine if and how visceral fat and metabolic complications of obesity (type 2 diabetes mellitus, insulin resistance, chronic inflammation, etc) are causally associated with bone status and fragility fracture risk. Vitamin D deficiency and hypogonadism may also influence fracture risk in obese individuals. Fracture algorithms such as FRAX® might be expected to underestimate fracture probability. Studies specifically designed to evaluate the antifracture efficacy of different drugs in obese patients are not available; however, literature data may suggest that in obese patients higher doses of the bisphosphonates might be required in order to maintain efficacy against nonvertebral fractures. Therefore, the search for better methods for the identification of fragility fracture risk in the growing population of adult and elderly subjects with obesity might be considered a clinical priority which could improve the prevention of fracture in obese individuals.