A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects

doi:10.1016/j.nut.2004.05.014

Nutrition

Volume 20, Issue 9, September 2004, Pages 769-771

https://doi.org/10.1016/j.nut.2004.05.014 Get rights and content

Abstract

Objective

In a large sample of elderly subjects, we assessed the possible protective effect of obesity on the development of osteoporosis.

Methods

Healthy subjects 70 y or older and of low socioeconomic level were studied. Bone mineral density was measured in the femoral neck by using a Lunar Prodigy double beam densitometer and compared measurements with appropriate standards. Osteoporosis was defined according to criteria of the World Health Organization (WHO). Body weight and height were recorded simultaneously, and body mass index (BMI) was calculated as weight (kg) divided by height (m²). Age-adjusted odds ratios for femoral osteoporosis were calculated for WHO-proposed BMI ranges in women and men, with an odds of one for a BMI below 25 kg/m².

Results

Eight hundred forty-five subjects (615 women and 230 men; mean age, 75 ± 4.4 y) were studied. Mean BMI was 28.1 ± 4.7 kg/m². Twenty five percent of women and 11% of men had osteoporosis (P < 0.001). Forward stepwise multiple regression analysis showed BMI to be the best independent predictor of bone mineral density in women and men. The age-adjusted odds ratios for femoral osteoporosis were 0.34 (95% confidence interval [CI], 0.21 to 0.55) and 0.13 (95% CI, 0.04 to 0.43) for women and men with a BMI between 25 and 30 kg/m², respectively. The odds ratios for women and men with a BMI between 30 and 35 kg/m² were 0.21 (95% CI, 0.11 to 0.39) and 0.09 (95% CI, 0.01 to 0.67), respectively

Conclusions

This study confirms the protective effect of a high BMI on femoral neck bone mineral density among elderly subjects. The risk for osteoporosis among men and women with a BMI above 30 kg/m² was approximately 33% compared with subjects with a normal BMI.

Introduction

Falls and fractures are an important source of disability and death among the elderly. One of the most important risk factors for fractures in this age group is osteoporosis.1

The prevalence of femoral neck osteoporosis in the elderly is 20% in the United States and Europe.2 Nutritional factors such as low intakes of protein and vitamin K3, 4 and low levels of vitamin D,5 influenced by less sun exposure and decreased skin synthesis of vitamin D,6 contribute to the higher risk of osteoporosis in the elderly.7

Obesity is frequent among elderly subjects. The secular changes in body composition lead to a progressive decline in lean body mass and replacement by fat mass. In men and women, obesity appears to be a protective factor against osteoporosis.8 The mechanisms involved are the higher production of estrogens by adipose tissue aromatase, higher leptin levels,9 or a gravitational effect caused by increased body weight10 .

We previously studied elderly subjects of low socioeconomic status and found that nutritional supplementation improves bone mineral density and induces a gain in fat mass and body weight.11 This last effect can be considered adverse unless it also provides protection against osteoporosis. The aim of the present study was to assess, in a larger sample of elderly subjects, the possible protective effect of obesity on the development of osteoporosis.

Section snippets

Materials and methods

Healthy free-living subjects 70 y or older of low socioeconomic status were studied. Exclusion criteria were the use of systemic adrenal steroids, estrogen replacement therapy, or bisphosphonates and the presence of chronic debilitating diseases such as cardiac failure, renal failure, or cancer. All subjects were offered free measurement of femoral bone mineral density and transport to the clinical facilities.

Bone mineral density was measured in the femoral neck with a Lunar Prodigy double beam

Results

Eight hundred forty-five subjects (615 women; mean age, 75 ± 4.4 y) were studied. Mean BMI was 28.1 ± 4.7 kg/m². Twenty-five percent of women and 11% of men had osteoporosis (P < 0.001).

Anthropometric and demographic data of the sample are presented in Table I. There was a positive correlation between femoral neck bone mineral density and weight, height, and BMI and a negative correlation with age (Table II).

Forward stepwise multiple regression analysis showed BMI to be the best independent

Discussion

Other studies have shown the protective effect of a high BMI against osteoporosis in middle-age and elderly men and women.14 Longitudinally, there is also an association between changes in BMI and changes in bone mineral density.15

There is also a

Acknowledgements

The authors thank Rosa Rivera for skillful technical assistance, Nancy Cruz for invaluable assistance, and the outpatient clinics Consultorio La Faena, Consultorio Aníbal Ariztía, Consultorio Félix de Amesti, and Consultorio Rosita Renard for their generous collaboration in carrying out this study.

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^☆: This study was supported by a grant from Nestec.

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Applied nutritional investigationA high body mass index protects against femoral neck osteoporosis in healthy elderly subjects☆

Abstract

Objective

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Rheum Dis Clin North Am

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Nutr

Am J Med

Lancet

Prevalence of low femoral bone density in older U.S. adults from NHANES III

J Bone Miner Res

Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial

Ann Intern Med

Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older

N Engl J Med

Obesity as a protective factor for postmenopausal osteoporosis

Int J Obes Relat Metab Disord

Applied nutritional investigation
A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects☆