{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:13:51Z","timestamp":1791598431922,"version":"4.3.4"},"reference-count":60,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2013,6,17]],"date-time":"2013-06-17T00:00:00Z","timestamp":1371427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,1,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>\u2003<\/jats:title>\n                    <jats:p>Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20\u2013105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI \u2265 30\u2009kg\/m2) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25\u2009kg\/m2, the hazard ratio (HR) for osteoporotic fracture at a BMI of 35\u2009kg\/m2 was 0.87 (95% confidence interval [CI], 0.85\u20130.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09\u20131.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored. \u00a9 2014 American Society for Bone and Mineral Research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jbmr.2017","type":"journal-article","created":{"date-parts":[[2013,6,17]],"date-time":"2013-06-17T06:08:38Z","timestamp":1371449318000},"page":"223-233","source":"Crossref","is-referenced-by-count":430,"title":["A Meta-Analysis of the Association of Fracture Risk and Body Mass Index in Women"],"prefix":"10.1093","volume":"29","author":[{"given":"Helena","family":"Johansson","sequence":"first","affiliation":[{"name":"Centre for Bone and Arthritis Research (CBAR) at the Sahlgrenska Academy, Institute of MedicineUniversity of GothenburgGothenburgSweden"},{"name":"WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Kanis","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Od\u00e9n","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene","family":"McCloskey","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of SheffieldUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland D","family":"Chapurlat","sequence":"additional","affiliation":[{"name":"INSERM UMR 1033Universit\u00e9 de LyonH\u00f4pital E HerriotLyonFrance"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Center for Clinical and Basic ResearchBallerupDenmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve R","family":"Cummings","sequence":"additional","affiliation":[{"name":"San Francisco Coordinating Center, California Pacific Medical Center Research InstituteUniversity of CaliforniaSan FranciscoCAUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo","family":"Diez-Perez","sequence":"additional","affiliation":[{"name":"Departament de Medicina, Hospital del Mar IMIM-UAB-RETICEFBarcelonaSpain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Eisman","sequence":"additional","affiliation":[{"name":"Clinical Excellence and Research, Sydney School of MedicineNotre Dame UniversitySydneyAustralia"},{"name":"St Vincent's Clinical School, The University of New South WalesAustralia"},{"name":"Clinical Translation and Advanced Education, Osteoporosis and Bone BiologyGarvan Institute of Medical Research, St Vincent's HospitalSydneyAustralia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeko","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Health Management & Promotion CenterHiroshima Atomic Bomb Casualty CouncilHiroshimaJapan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus-C","family":"Gl\u00fcer","sequence":"additional","affiliation":[{"name":"Sektion Biomedizinische Bildgebung, Klinik f\u00fcr RadiologieUniversit\u00e4tsklinikum Schleswig-HolsteinKielGermany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Goltzman","sequence":"additional","affiliation":[{"name":"Department of MedicineMcGill UniversityMontrealCanada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didier","family":"Hans","sequence":"additional","affiliation":[{"name":"Department of Bone & Joint, Center of Bone DiseasesLausanne University HospitalLausanneSwitzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay-Tee","family":"Khaw","sequence":"additional","affiliation":[{"name":"Department of Public Health and Primary CareUniversity of CambridgeUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc-Antoine","family":"Krieg","sequence":"additional","affiliation":[{"name":"Department of Musculoskeletal MedicineCHUVLausanneSwitzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Kr\u00f6ger","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and TraumatologyKuopio University HospitalKuopioFinland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Z","family":"LaCroix","sequence":"additional","affiliation":[{"name":"Fred Hutchinson Cancer Research CenterSeattleUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edith","family":"Lau","sequence":"additional","affiliation":[{"name":"Hong Kong Orthopaedic and Osteoporosis Center for Treatment and ResearchHong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William D","family":"Leslie","sequence":"additional","affiliation":[{"name":"Department of MedicineUniversity of ManitobaWinnipegCanada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Mellstr\u00f6m","sequence":"additional","affiliation":[{"name":"Centre for Bone and Arthritis Research (CBAR) at the Sahlgrenska Academy, Institute of MedicineUniversity of GothenburgGothenburgSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"L Joseph","family":"Melton","sequence":"additional","affiliation":[{"name":"Division of EpidemiologyCollege of Medicine, Mayo ClinicRochesterMNUSA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence W","family":"O'Neill","sequence":"additional","affiliation":[{"name":"Utrecht Institute for Pharmaceutical SciencesUtrecht UniversityUtrechtThe Netherlands"},{"name":"Arthritis and Rheumatism Council (ARC), Epidemiology Research UnitUniversity of ManchesterManchesterUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A","family":"Pasco","sequence":"additional","affiliation":[{"name":"School of MedicineDeakin UniversityGeelongAustralia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerilynn C","family":"Prior","sequence":"additional","affiliation":[{"name":"Department of Medicine and EndocrinologyUniversity of British ColumbiaVancouverCanada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M","family":"Reid","sequence":"additional","affiliation":[{"name":"School of Medicine & DentistryUniversity of AberdeenAberdeenUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Rivadeneira","sequence":"additional","affiliation":[{"name":"Department of Internal MedicineErasmus MC RotterdamThe 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