Clinical research studyObesity Is Not Protective against Fracture in Postmenopausal Women: GLOW
Section snippets
Methods
GLOW is a prospective cohort study involving 723 physician practices at 17 sites in 10 countries (Australia, Belgium, Canada, France, Germany, Italy, Netherlands, Spain, UK, and US). The study methods have been described previously.9 In brief, practices typical of each region were recruited through primary care networks organized for administrative, research, or educational purposes, or by identifying all physicians in a geographic area. Each site obtained local ethics committee approval to
Results
Of 60,393 women enrolled at baseline, 46,443 (76.9%) completed both 1- and 2-year surveys. We further excluded one woman with a BMI of 130 kg/m2 and 1908 women with incomplete information on BMI or fracture history, leaving 44,534 women for further analysis. Among the 57,556 women enrolled at baseline with BMI data, 23.8% were obese, 74.4% were nonobese, and 1.9% were underweight. Of the 44,534 women analyzed, the corresponding figures were 23.4%, 74.9%, and 1.7%, respectively. Average ages
Discussion
Our results challenge the widespread belief that obesity is protective against fracture, and indeed suggest that obesity is a risk factor for certain fractures, particularly those of the ankle and upper leg. In this large, population-based cohort of postmenopausal women, the rates of both previous and incident fracture in obese women were similar to those observed in nonobese women. Although the highest fracture rates occurred in underweight women, the small proportion of women in the
Conclusions
The finding that obesity is not protective against fracture in postmenopausal women and is associated with increased risk of incident upper leg and ankle fractures has major public health implications. The morbidity and economic costs associated with fractures in the obese population are likely to be higher than in nonobese women because of a greater risk of nonunion, postoperative complications, comorbidities, and slower rehabilitation.54, 55 Furthermore, in view of the rapidly rising
Acknowledgment
We thank the physicians and study coordinators participating in GLOW, the staff at the Center for Outcomes Research, and Linda Chase for secretarial support. Sophie Rushton-Smith coordinated revisions and provided editorial assistance including editing, checking content and language, formatting and referencing.
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Funding: Financial support for the GLOW study is provided by Warner Chilcott Company, LLC and sanofi-aventis to the Center for Outcomes Research, University of Massachusetts Medical School. JEC acknowledges support from the Cambridge Biomedical Research Centre and National Institute for Health Research (NIHR).
Conflict of Interest: None.
Authorship: All authors conceived and designed the study, critically revised the draft for important intellectual content, and gave final approval of the version to be published. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.