Obesity and osteoporotic fractures

In: Romanian Journal of Military Medicine, Volume 123, Issue 3, p. 166-161

Abstract

Obesity correlates with a higher risk of fractures in some sites as vertebras, upper arm, and legs. This is a narrative mini-review focused on several key points that link obesity with osteoporosis. Waist circumference may a better predictor of fractures than body mass index (BMI) in obese females. Even obese menopausal women have an extra source of estrogens in fat tissue this actually is not enough to offer a complete protection against osteoporotic fractures. Low levels of testosterone in males induce a higher risk of fall dependent or independent of sarcopenia (which is more evident in elderly). High BMI is correlated with vitamin D deficiency. Obesity is a contributor to muscle damage and decline due to fat accumulation and inefficient fuel utilisation by the muscle, namely sarcopenic obesity, regardless the age. Associated type 2 diabetes mellitus involves bone damage and fracture risk due to glycated proteins of the matrix, the changes of adipokines, increased cortical porosity, high risk of fall because of blood pressure and glycaemia anomalies, visual disturbances, renal and peripheral nerves diabetes-associated conditions etc. The fracture risk is also augmented via fat derived cytokines and chronic inflammation. Even it seems logical that the weight correction though bariatric surgery reduces the fracture risk in obesity, actually data from longitudinal studies pointed that, despite the procedure is life saving, it does not actually protect against osteoporosis which is regarded as a potential long-term complication. A high fracture burden in obesity should increase the level of awareness for practitioners of different medical areas due to multiple levels of complications and to the epidemiological impact of obesity.