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Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort

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Abstract

Summary

Larger waist circumference is significantly associated with an increased risk of distal lower limb fractures in individuals aged 40–70 years with a body mass index within the normal or overweight category. Therefore, waist circumference provides additive information to body mass index for the identification of individuals at risk of obesity-related fractures.

Introduction

Waist circumference (WC) is a stronger risk factor of metabolic disorders than body mass index (BMI), but whether it holds true for fracture risk prediction remains unclear. We aimed to evaluate relationships between WC and fracture incidence within BMI categories and evaluate whether BMI modifies these relationships.

Methods

Men and women aged 40–70 years from the CARTaGENE cohort were divided by BMI category at baseline: normal weight, overweight, and obesity. Incident fractures were identified over 7 years via linkage with healthcare administrative databases. Cox proportional hazard models estimated the relationships between WC and incident fractures at any site and by skeletal site within each BMI category. Results are reported as adjusted hazard ratios (95% confidence intervals) per 10 cm increase in WC. Effect modification was evaluated qualitatively by comparing relationships between BMI categories.

Results

Of the 18 236 individuals included, 754 sustained a fracture. Significant relationships were found between WC and distal lower limb fractures in the normal (1.25 [1.08, 1.45]) and overweight (1.28 [1.07, 1.52]) BMI categories, but not in the obesity category. In the overweight category, we found an increased risk of distal upper limb fractures with increasing WC (1.49 [1.04, 2.15]). No significant relationship was observed regarding WC and fracture risk at any site or major osteoporotic fractures. An effect modification of BMI on the relationships between WC and distal lower limb fractures was observed.

Conclusion

WC provides both independent and additive information to BMI for the identification of individuals at risk of obesity-related fractures.

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Acknowledgements

No author received specific funding for this work. AFT received a doctoral scholarship from the Canadian Institutes for Health Research (CIHR) (2020-2023). SNM is a scholar from the Fonds de Recherche du Québec-Santé (FRQ-S). FM received research funds and advisory board honorarium from Amgen, Baxter, and Astra-Zeneca. He also holds a scholarship from FRQ-S and a research chair in nephrology at Université Laval. He is also supported by the Department of Medicine and the Fondation du CHU de Québec-Université Laval. CG is a scholar from the FRQ-S, a recipient of a New investigator award from Diabetes Canada, and holds a research chair in endocrinology at CHU de Québec-Université Laval.

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Authors and Affiliations

  1. Endocrinology and Nephrology Unit, CHU de Quebec-Université Laval Research Centre, Quebec City, Canada

    Anne-Frédérique Turcotte, Fabrice Mac-Way & Claudia Gagnon

  2. Quebec Heart and Lung Institute Research Centre, Quebec City, Canada

    Anne-Frédérique Turcotte & Claudia Gagnon

  3. Department of Medicine, Laval University, Quebec City, Canada

    Anne-Frédérique Turcotte, Fabrice Mac-Way & Claudia Gagnon

  4. Bureau d’information et études en santé des populations, Institut national de santé publique du Québec, Quebec City, Canada

    Sonia Jean

  5. Department of Social and Preventive Medicine, Laval University, Quebec City, Canada

    Sonia Jean

  6. Department of Medicine, Faculty of Medicine, McGill University, Montreal, Canada

    Suzanne N. Morin

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  1. Anne-Frédérique Turcotte
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Correspondence to Claudia Gagnon.

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Anne-Frédérique Turcotte, Sonia Jean, Suzanne N Morin, Fabrice Mac-Way and Claudia Gagnon declare that they have no conflict of interest.

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Turcotte, AF., Jean, S., Morin, S.N. et al. Added value of waist circumference to body mass index for predicting fracture risk in obesity: a prospective study from the CARTaGENE cohort. Arch Osteoporos 18, 92 (2023). https://doi.org/10.1007/s11657-023-01302-1

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