{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:13:08Z","timestamp":1788243188272,"version":"build-2803163510"},"reference-count":52,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,3,3]],"date-time":"2023-03-03T00:00:00Z","timestamp":1677801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JBMR Plus"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    The association between obesity and fracture risk is complex and may vary by definition of obesity, skeletal site, and sex. We aimed to evaluate the relationships between obesity, defined using body mass index (BMI) or waist circumference (WC), and fracture incidence at any site and by skeletal site (i.e., major osteoporotic fractures [MOFs], distal lower limb fractures [tibia, ankle, feet], and distal upper limb fractures [forearm\/elbow, wrist]). The secondary aim was to assess the aforementioned relationships by sex. We used CARTaGENE, a large population\u2010based cohort of individuals aged 40\u201370\u2009years from Quebec, Canada, who were assessed in 2009\u20132010. Incident fractures were identified via linkage with healthcare administrative databases over a 7\u2010year period. Cox proportional hazard models adjusted for several potential confounders were used to estimate the relationships, with exposures treated as continuous variables. Results are reported as adjusted hazard ratios (aHRs) and 95% confidence intervals. We identified 19\u2009357 individuals (mean\u2009\u00b1\u2009standard deviation: age 54\u2009\u00b1\u20098\u2009years, BMI 27\u2009\u00b1\u20095\u2009kg\/m\n                    <jats:sup>2<\/jats:sup>\n                    , WC 94\u2009\u00b1\u200914\u2009cm; 51.6% women). During follow\u2010up, 497 women and 323 men sustained a fracture. There was a linear relationship between fracture incidence and WC, while cubic splines best fitted the relationship for BMI. Greater WC was associated with an increased risk of fracture at the distal lower limbs in the whole cohort and in the subgroup of women: aHR for each 10\u2009cm increased in WC of 1.12 (1.03, 1.21) and 1.12 (1.01, 1.24), respectively. In men, WC was not significantly associated with any fracture outcome. Higher BMI was also significantly associated with distal lower limb fracture risk in the whole cohort (\n                    <jats:italic>p<\/jats:italic>\n                    \u00a0=\u00a00.018). No significant relationships were found between either WC or BMI and the risk of any fracture, MOFs, and distal upper limb fractures. In middle\u2010aged individuals, obesity, and mainly abdominal obesity, was associated with distal lower limb fracture risk. \u00a9 2023 The Authors.\n                    <jats:italic>JBMR Plus<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.\n                  <\/jats:p>","DOI":"10.1002\/jbm4.10730","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:14:43Z","timestamp":1675728883000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Relationships between Obesity and Incidence of Fractures in a\n                    <scp>Middle\u2010Aged<\/scp>\n                    Population: A Study from the\n                    <scp>CARTaGENE<\/scp>\n                    Cohort"],"prefix":"10.1093","volume":"7","author":[{"given":"Anne\u2010Fr\u00e9d\u00e9rique","family":"Turcotte","sequence":"first","affiliation":[{"name":"Endocrinology and Nephrology Unit CHU de Quebec\u2010Universit\u00e9 Laval Research Centre  Quebec City Quebec Canada"},{"name":"Quebec Heart and Lung Institute Research Centre  Quebec City Quebec Canada"},{"name":"Faculty and Department of Medicine Laval University  Quebec City Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Jean","sequence":"additional","affiliation":[{"name":"Bureau d'information et \u00e9tudes en sant\u00e9 des populations Institut national de sant\u00e9 publique du Qu\u00e9bec  Qu\u00e9bec City Quebec Canada"},{"name":"Department of Social and Preventive Medicine Laval University  Quebec City Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4317-492X","authenticated-orcid":false,"given":"Suzanne N.","family":"Morin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Faculty of Medicine McGill University  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrice","family":"Mac\u2010Way","sequence":"additional","affiliation":[{"name":"Endocrinology and Nephrology Unit CHU de Quebec\u2010Universit\u00e9 Laval Research Centre  Quebec City Quebec Canada"},{"name":"Faculty and Department of Medicine Laval University  Quebec City Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-962X","authenticated-orcid":false,"given":"Claudia","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Endocrinology and Nephrology Unit CHU de Quebec\u2010Universit\u00e9 Laval Research Centre  Quebec City Quebec Canada"},{"name":"Quebec Heart and Lung Institute Research Centre  Quebec City Quebec Canada"},{"name":"Faculty and Department of Medicine Laval University  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