Effect of BMI-discordant abdominal tissue thickness on fracture probability: a registry-based study
Effect of BMI-discordant abdominal tissue thickness on fracture probability: a registry-based study
FRAX®, which is used to assess fracture probability, considers body mass index (BMI) but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by DXA and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (< -2 cm, -2 to -1 cm) to higher (1 to 2 cm, > +2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (HR 1.23, 95% CI 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects prior to age 65 years (HR 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes there was also increased risk for those in the lowest ATI category (HR 1.73, 95% CI 1.12-2.65 for MOF, 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not seen in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. This article is protected by copyright. All rights reserved.
DUAL-ENERGY X-RAY ABSORPTIOMETRY, FRACTURE RISK ASSESSMENT, FRAX, OBESITY, OSTEOPOROSIS
1749-1756
Leslie, William D.
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Binkley, Neil
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Schousboe, John T.
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McCloskey, Eugene V.
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Johansson, Helena
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Harvey, Nicholas C.
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Kanis, John A.
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December 2023
Leslie, William D.
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Binkley, Neil
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Schousboe, John T.
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McCloskey, Eugene V.
2f057a16-3d4e-4597-80c7-6ce47f969c78
Johansson, Helena
04f12338-4dd1-437b-b9bc-e0884130c215
Harvey, Nicholas C.
ce487fb4-d360-4aac-9d17-9466d6cba145
Kanis, John A.
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Leslie, William D., Binkley, Neil, Schousboe, John T., McCloskey, Eugene V., Johansson, Helena, Harvey, Nicholas C. and Kanis, John A.
(2023)
Effect of BMI-discordant abdominal tissue thickness on fracture probability: a registry-based study.
Journal of Bone and Mineral Research, 38 (12), .
(doi:10.1002/jbmr.4919).
Abstract
FRAX®, which is used to assess fracture probability, considers body mass index (BMI) but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by DXA and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (< -2 cm, -2 to -1 cm) to higher (1 to 2 cm, > +2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (HR 1.23, 95% CI 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects prior to age 65 years (HR 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes there was also increased risk for those in the lowest ATI category (HR 1.73, 95% CI 1.12-2.65 for MOF, 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not seen in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. This article is protected by copyright. All rights reserved.
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Leslie JBMR 2023
- Accepted Manuscript
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J of Bone Mineral Res - 2023 - Leslie - Effect of BMI‐Discordant Abdominal Tissue Thickness on Fracture Probability A
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Accepted/In Press date: 25 September 2023
e-pub ahead of print date: 30 September 2023
Published date: December 2023
Additional Information:
Funding Information:
The authors acknowledge the Manitoba Centre for Health Policy for use of data contained in the Population Health Research Data Repository (HIPC 2016/2017-29). The results and conclusions are those of the authors and no official endorsement by the Manitoba Centre for Health Policy, Manitoba Health, Healthy Living, and Seniors, or other data providers is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.
Publisher Copyright:
© 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords:
DUAL-ENERGY X-RAY ABSORPTIOMETRY, FRACTURE RISK ASSESSMENT, FRAX, OBESITY, OSTEOPOROSIS
Identifiers
Local EPrints ID: 482518
URI: http://eprints.soton.ac.uk/id/eprint/482518
ISSN: 0884-0431
PURE UUID: 378203c7-381d-4bbf-b9a3-ef321aa5b479
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Date deposited: 10 Oct 2023 16:41
Last modified: 18 Mar 2024 02:59
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Contributors
Author:
William D. Leslie
Author:
Neil Binkley
Author:
John T. Schousboe
Author:
Eugene V. McCloskey
Author:
Helena Johansson
Author:
John A. Kanis
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