Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women

Juliet E Compston; Allison Wyman; Gordon FitzGerald; Jonathan D Adachi; Roland D Chapurlat; Cyrus Cooper; Adolfo Díez-Pérez; Stephen H Gehlbach; Susan L Greenspan; Frederick H Hooven; Andrea Z LaCroix; Lyn March; J Coen Netelenbos; Jeri W Nieves; Johannes Pfeilschifter; Maurizio Rossini; Christian Roux; Kenneth G Saag; Ethel S Siris; Stuart Silverman; Nelson B Watts; Frederick A Anderson Jr

doi:10.1002/jbmr.2810

Increase in Fracture Risk Following Unintentional Weight Loss in Postmenopausal Women: The Global Longitudinal Study of Osteoporosis in Women

J Bone Miner Res. 2016 Jul;31(7):1466-72. doi: 10.1002/jbmr.2810.

Authors

Juliet E Compston¹, Allison Wyman², Gordon FitzGerald², Jonathan D Adachi³, Roland D Chapurlat⁴, Cyrus Cooper⁵, Adolfo Díez-Pérez^{6

7}, Stephen H Gehlbach², Susan L Greenspan⁸, Frederick H Hooven⁹, Andrea Z LaCroix¹⁰, Lyn March¹¹, J Coen Netelenbos¹², Jeri W Nieves¹³, Johannes Pfeilschifter¹⁴, Maurizio Rossini¹⁵, Christian Roux¹⁶, Kenneth G Saag¹⁷, Ethel S Siris¹⁸, Stuart Silverman¹⁹, Nelson B Watts²⁰, Frederick A Anderson Jr¹

Affiliations

¹ Cambridge Biomedical Campus, Cambridge, UK.
² Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA.
³ St Joseph's Healthcare, McMaster University, Hamilton, Canada.
⁴ Division of Rheumatology, INSERM U1033, Université de Lyon, Hôpital E Herriot, Lyon, France.
⁵ MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
⁶ Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain.
⁷ RETICEF, Instituto Carlos III, Madrid, Spain.
⁸ University of Pittsburgh, Pittsburgh, PA, USA.
⁹ University of Massachusetts Medical School, Worcester, MA, USA.
¹⁰ Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
¹¹ University of Sydney Institute of Bone and Joint Research and Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia.
¹² Department of Endocrinology, VU University Medical Center, Amsterdam, Netherlands.
¹³ Helen Hayes Hospital and Columbia University, West Haverstraw, NY, USA.
¹⁴ Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany.
¹⁵ Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy.
¹⁶ Paris Descartes University, Cochin Hospital, Paris, France.
¹⁷ Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁸ Columbia University Medical Center, New York, NY, USA.
¹⁹ Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
²⁰ Mercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USA.

Abstract

Increased fracture risk has been associated with weight loss in postmenopausal women, but the time course over which this occurs has not been established. The aim of this study was to examine the effects of unintentional weight loss of ≥10 lb (4.5 kg) in postmenopausal women on fracture risk at multiple sites up to 5 years after weight loss. Using data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), we analyzed the relationships between self-reported unintentional weight loss of ≥10 lb at baseline, year 2, or year 3 and incident clinical fracture in the years after weight loss. Complete data were available in 40,179 women (mean age ± SD 68 ± 8.3 years). Five-year cumulative fracture rate was estimated using the Kaplan-Meier method, and adjusted hazard ratios for weight loss as a time-varying covariate were calculated from Cox multiple regression models. Unintentional weight loss at baseline was associated with a significantly increased risk of fracture of the clavicle, wrist, spine, rib, hip, and pelvis for up to 5 years after weight loss. Adjusted hazard ratios showed a significant association between unintentional weight loss and fracture of the hip, spine, and clavicle within 1 year of weight loss, and these associations were still present at 5 years. These findings demonstrate increased fracture risk at several sites after unintentional weight loss in postmenopausal women. This increase is found as early as 1 year after weight loss, emphasizing the need for prompt fracture risk assessment and appropriate management to reduce fracture risk in this population. © 2016 American Society for Bone and Mineral Research.

Keywords: FRACTURE; POSTMENOPAUSAL WOMEN; WEIGHT LOSS.

Publication types

Clinical Trial
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Follow-Up Studies
Fractures, Bone / epidemiology*
Fractures, Bone / etiology
Humans
Longitudinal Studies
Middle Aged
Postmenopause*
Risk Assessment
Risk Factors
Time Factors
Weight Loss*

Abstract

Publication types

MeSH terms

Grants and funding