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We estimated hazard ratios (HRs) of fracture for baseline body mass index (BMI), BMI change during the prior 12 and 18\u2009years, baseline waist-to-height ratio, total and regional distribution of fat and lean mass, with and without areal bone mineral density (BMD) adjustment. During follow-up (median 8.7\u2009years), 7290 individuals sustained a fracture, including 4279 fragility fractures, of which 1813 were hip fractures. Higher baseline BMI and prior gain in BMI were inversely associated with all types of fracture. Lower fracture rate with higher baseline BMI was seen within every category of prior BMI change, whereas higher prior BMI gain conferred a lower rate of fracture within those with normal baseline BMI. Each standard deviation (SD) higher baseline waist-to-height ratio, after adjustment for BMI, was associated with higher rates of hip fracture in both women and men (HR 1.12; 95% CI, 1.05\u20131.19). In the subcohort (median follow-up 10\u2009years), higher baseline fat mass index (FMI) and appendicular lean mass index (LMI) showed fracture-protective effects. After BMD adjustment, higher baseline BMI, total LMI, FMI, and higher prior BMI gain were associated with higher fracture rate. Baseline fat distribution also was associated with fracture rate; a 1-SD higher android to gynoid fat mass ratio in prior BMI gainers was associated with BMD-adjusted HRs of 1.16 (95% CI, 1.05\u20131.28) for any fracture and 1.48 (95% CI, 1.16\u20131.89) for hip fracture. This pattern was not observed among prior BMI losers. These findings indicate that for optimal fracture prevention, low baseline BMI, prior BMI loss and high baseline central obesity should be avoided in both women and men. \u00a9 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).<\/jats:p>","DOI":"10.1002\/jbmr.4298","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T12:04:55Z","timestamp":1617105895000},"page":"1288-1299","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Prior loss of body mass index, low body mass index, and central obesity independently contribute to higher rates of fractures in elderly women and men"],"prefix":"10.1093","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2891-9273","authenticated-orcid":false,"given":"Rui","family":"Zheng","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology Uppsala University Uppsala 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Health University of North Carolina Chapel Hill North Carolina USA"},{"name":"Department of Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA"},{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2815-1217","authenticated-orcid":false,"given":"Karl","family":"Micha\u00eblsson","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Unit of Medical Epidemiology Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,3,30]]},"reference":[{"issue":"10","key":"2024012713475718900_jbmr4298-bib-0001","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/S2213-8587(14)70034-8","article-title":"Age-related and disease-related muscle loss: the effect of diabetes, obesity, and other 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