Detecting Associations Between Body Mass Index and Bone Mineral Density in Patients with Fractures of Different Localizations

Introduction. Osteoporosis is a multifactorial metabolic disease that increases the risk of bone fracture because of reduced bone mineral density. The International Osteoporosis Foundation estimates that about 200 million people are affected by osteoporosis. Therefore, it is relevant to develop clinical and diagnostic methods that would make it possible to effectively predict fracture risks in different parts of the skeleton and, based on population studies, to accurately predict the course of the disease. Aim. To study the levels of body mass index and bone mineral density in men and women with fractures of different localizations. Materials and methods. 828 postmenopausal women (61.94 ± 7.98 years) and 496 men over 50 years (62.03 ± 10.83 years) were examined. Bone mineral density (BMD) was measured by means of two-phase Dual-energy X-ray absorptiometry (DEXA) using QDR 4500A (Hologic, USA) in standard locations. Body mass index (BMI) was also assessed. Results and discussion. The study has revealed associations between BMI and peripheral bone fractures, BMD of the lumbar vertebrae and fractures of the peripheral bones and spine, BMD of the femoral neck and fractures of this localization in women. In men, associations were revealed between BMI, BMD of the lumbar spine and fractures of all localizations, as well as between BMD of the femoral neck and spinal fractures and concomitant fractures. Conclusion. In women, a decrease in BMD of the femoral neck enhances the risk of fractures in general, BMD of the lumbar spine — only the risk of fractures of this localization. In men, a decline in BMD of both the lumbar spine and the femoral neck increases the risk of fractures of various localizations. Reduced BMI enhances the risk of fractures in general in both men and women.

1. Anthamatten A., Parish A. Clinical update on osteoporosis. J Midwifery Womens Health. 2019;64(3):265–75. DOI: 10.1111/jmwh.12954

2. Salari N., Ghasemi H., Mohammadi L., Behzadi M.H., Rabieenia E., Shohaimi S., et al. The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis. J Orthop Surg Res. 2021;16(1):609. DOI: 10.1186/s13018-021-02772-0.

3. Dudinskaya E.N., Tkacheva O.N., Machekhina L.V., Ostapenko V.S., Brailova N.V. Use of teriparatide in treatment of severe osteoporosis in geriatric practice: a clinical case review. Obesity and metabolism. 2019;16(4):80–9 (In Russ.). DOI: 10.14341/omet10052

4. Kanis J.A., Cooper C., Rizzoli R., Reginster J.Y. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2019;30(1):3–44. DOI: 10.1007/s00198-0184704-5

5. Cozadd A.J., Schroder L.K., Switzer J.A. Fracture risk assessment: an update. J Bone Joint Surg Am. 2021;103(13):1238–46. DOI: 10.2106/JBJS.20.01071

6. Shevroja E., Cafarelli F.P., Guglielmi G., Hans D. DXA parameters, trabecular bone score (TBS) and bone mineral density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis. Endocrine. 2021;74(1):20–8. DOI: 10.1007/s12020-021-02806-x

7. De Laet C., Kanis J.A., Odén A., Johanson H., Johnell O., Delmas P., et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16(11):1330–8. DOI: 10.1007/s00198-005-1863-y

8. Xiang B.Y., Huang W., Zhou G.Q., Hu N., Chen H., Chen C. Body mass index and the risk of low bone mass-related fractures in women compared with men: A PRISMA-compliant meta-analysis of prospective cohort studies. Medicine (Baltimore). 2017;96(12):e5290. DOI: 10.1097/MD.0000000000005290

9. Guagnelli M.Á., Winzenrieth R., Deleze M., Cons-Molina F., Clark P. Description of normative spine TBS data for men and women in mexican population. J Clin Densitom. 2021;24(1):129–34. DOI: 10.1016/j.jocd.2020.06.003

10. Khosla S., Monroe D.G. Regulation of bone metabolism by sex steroids. Cold Spring Harb Perspect Med. 2018;8(1):a031211. DOI: 10.1101/cshperspect.a031211

11. van Dort M.J., Driessen J.H.M., Geusens P., Romme E.A.P.M., Smeenk F.W.J.M., Wouters E.F.M., et al. Vertebral bone attenuation in Hounsfield Units and prevalent vertebral fractures are associated with the short-term risk of vertebral fractures in current and ex-smokers with and without COPD: a 3-year chest CT follow-up study. Osteoporos Int. 2019;30(8):1561–71. DOI: 10.1007/s00198-019-04977-w

12. Christiansen B.A., Harrison S.L., Fink H.A., Lane N.E. Incident fracture is associated with a period of accelerated loss of hip BMD: the study of osteoporotic fractures. Osteoporos Int. 2018;29(10):2201–9. DOI: 10.1007/s00198-018-4606-6

13. Wright N.C., Hooker E.R., Nielson C.M., Ensrud K.E., Harrison S.L., Orwoll E.S., et al. The epidemiology of wrist fractures in older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int. 2018;29(4):859–70. DOI: 10.1007/s00198-017-4349-9

14. Shin M.H., Zmuda J.M., Barrett-Connor E., Sheu Y., Patrick A.L., Leung P.C., et al. Race/ethnic differences in associations between bone mineral density and fracture history in older men. Osteoporos Int. 2014;25(3):837–45. DOI: 10.1007/s00198-013-2503-6

15. Harvey N.C., Odén A., Orwoll E., Lapidus J., Kwok T., Karlsson M.K., et al. Measures of physical performance and muscle strength as predictors of fracture risk independent of FRAX, falls, and aBMD: a metaanalysis of the osteoporotic fractures in men (MrOS) study. J Bone Miner Res. 2018;33(12):2150–7. DOI: 10.1002/jbmr.3556

16. Gajic-Veljanoski O., Papaioannou A., Kennedy C., Ioannidis G., Berger C., Kin On Wong A., et al. Osteoporotic fractures and obesity affect frailty progression: a longitudinal analysis of the Canadian multicentre osteoporosis study. BMC Geriatr. 2018;18:4. DOI: 10.1186/s12877-0170692-0

17. Shen J., Leslie W., Nielson C., Majumdar S., Morin S., Orwoll E. Associations of body mass index with incident fractures and hip structural parameters in a large canadian cohort. J Clin Endocrinol Metab. 2016;101(2):476–84. DOI: 10.1210/jc.2015-3123

18. Nethander M., Pettersson-Kymmer U., Vandenput L., Lorentzon M., Karlsson M., Mellström D., et al. BMD-related genetic risk scores predict site-specific fractures as well as trabecular and cortical bone microstructure. J Clin Endocrinol Metab. 2020;105(4):e1344–57. DOI: 10.1210/clinem/dgaa082

19. Samelson E.J., Broe K.E., Xu H., Yang L., Boyd S., Biver E., et al. Cortical and trabecular bone microarchitecture as an independent predictor of incident fracture risk in older women and men in the Bone Microarchitecture International Consortium (BoMIC): a prospective study. Lancet Diabetes Endocrinol. 2019;7(1):34–43. DOI: 10.1016/ S2213-8587(18)30308-5

20. Yalaev B., Tyurin A., Prokopenko I., Karunas A., Khusnutdinova E., Khusainova R. Using a polygenic score to predict the risk of developing primary osteoporosis. Int J Mol Sci. 2022;23(17):10021. DOI: 10.3390/ijms231710021

21. Tiurin A.V., Khusainova R.I., Gantseva Kh.Kh., Akhiiarova K.E., Sadretdinova L.D., Akhmetova A.M., Minigalina K.M.; Bashkir State Medical University. Method for predicting the development of flat feet in young people: Russian Federation patent 2784354 C1. 2022 May 06.