Stronger hip structure, greater BMD observed in young women with obesity vs normal weight
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Young women with obesity have a higher areal bone mineral density, better hip structure and higher volumetric BMD in all femoral compartments compared with women with normal weight, according to a study published in Bone.
Researchers used DXA-based 3D modeling to compare bone strength between young women with obesity and with normal weight. The obesity cohort had higher volumetric BMD and greater femoral bone strength, suggesting a different approach to fracture risk prediction than areal BMD.
“In this cross-sectional study in young women from 18 to 35 years old, we evaluated the effect of obesity on various bone parameters around peak bone mass acquisition, a crucial period that affects the risk of subsequent fracture in the elderly,” Laurent Maïmoun, PhD, assistant professor in the department of medicine at the University Hospital of Montpellier, France, and colleagues wrote. “In these conditions, obesity was associated with a significant increase in areal BMD, a conventional parameter measured by DXA, at partially loaded and loaded skeletal sites, and an improvement in volumetric BMD, bone geometry and bone strength at femoral regions determined by a DXA-based 3D modeling approach and hip structural analysis software, respectively.”
Researchers consecutively recruited 128 women aged 18 to 35 years with a BMI of 30 kg/m2 or higher in the endocrinology department of the University Hospital of Montpellier between June 2014 and November 2019. The cohort with obesity was age-matched with a control group of 92 women from the community with a BMI between 18 kg/m2 and 24.9 kg/m2 and no history of obesity, diabetes, hypertension or dyslipidemia. Participants provided their medical history through a questionnaire. Areal BMD was measured through DXA, and hip geometry and strength parameters were assessed through hip structural analysis. A 3D-shaper software (Galgo Medical) was used to assess volumetric BMD of the cortical, trabecular and integral bone compartments and mean cortical thickness.
Compared with the control group, women with obesity had significantly higher areal BMD at all bone sites, with a greater difference found in the hip (Cohen’s d = 1.38) compared with the lumbar spine (Cohen’s d = 0.654) and radius (Cohen’s d = 1.19). Women with obesity had higher areal BMD z scores at all bone sites compared with controls.
Except for endocortical diameter parameters at the intertrochanteric region and the femoral shaft, women with obesity had better hip structural analysis parameters compared with the control group. Volumetric BMD was significantly higher in the whole proximal femur and all femoral compartments compared with controls. The difference between the two groups was greater in cortical than trabecular volumetric BMD.
When hip bone parameters were modeled for each group, both the obesity and control cohorts reached maximal values from age 20 to 26 years. All bone DXA-derived parameters were higher for those with obesity, regardless of age.
In subgroup analysis, lean body mass was most strongly associated with all bone parameters in both groups except for 3D-DXA parameters in the obesity cohort.
The researchers said the next steps are to look more closely at whether parameters other than areal BMD would be better predictors for fracture risk.
“It now needs to be determined whether the evaluation of these new parameters improves the prediction of fracture risk, particularly in older women with obesity,” the researchers wrote. “Among the anthropometric parameters, lean body mass was most consistently associated with bone parameters, suggesting that this factor may have an important role in hip strength and thus in fracture risk.”
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