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Minimal trauma, lower leg fractures most common among adults with 'super obesity'
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NEW ORLEANS — Minimal-trauma fractures in the lower leg, forearm and upper shoulder are the most prevalent types in adults with a BMI of 50 kg/m2 or more, and comorbidities may be more to blame than elevated BMI, according to findings presented at the Endocrine Society Annual Meeting.
“As the U.S. population ages in the midst of a worsening obesity epidemic, we will likely see more fractures in patients suffering from high levels of obesity,” Amy E. Iwamaye, MD, of the department of metabolism, diabetes and endocrinology at Temple University Hospital in Philadelphia, told Endocrine Today. “As there is little research in this population, further investigation may help mitigate the increase in morbidity and mortality due to fracture.”
Iwamaye and colleagues examined electronic medical records to identify adults aged at least 40 years with “super obesity,” which they defined as a BMI of 50 kg/m2 or more. A total of 6,181 adults were identified, with a prior history of fracture observed in 2.3% of the cohort. Of the 172 fractures, the most common fracture site was at the lower leg or ankle (30.2%), with the forearm (15.7%), upper arm and shoulder (13.4%) and foot (11.6%) noted as other prevalent fracture sites. Of the 161 fractures with trauma information, most were of minimal trauma (62.7%) compared with minor trauma (18.6%) and major trauma (18.6%).
Among the super-obesity cohort, the researchers did not find an association between higher BMI and prior fracture in the lower leg and upper arm, but they noted that prior fractures were more likely in those who had a higher comorbidity index score (OR = 1.23 per 1-point increase; 95% CI, 1.12-1.36). In addition, they observed a negative association between higher BMI and prior fractures at all other sites (OR = 0.57 per 5 kg/m2; 95% CI, 0.4-0.81).
“We know that BMI is strongly associated with bone density. Because we found that lower leg and upper arm fractures were more strongly associated with comorbid conditions than BMI, it suggests that these patients may suffer these fractures due to non-skeletal reasons,” Iwamaye said. “This might suggest [that] strategies for fall prevention may be particularly important to implement in super-obese patients who fracture at the lower leg and upper arm. However, further research is needed to help to identify any unique risk factors that may help further steer screening, prevention and treatment intervention.”– by Phil Neuffer
Reference:
Iwamaye AE, et al. SAT-528. BMI and relationship to prior fracture in the super obese. Presented at: The Endocrine Society Annual Meeting; March 23-26, 2019; New Orleans.
Disclosure: The authors report no relevant financial disclosures.