Introduction
Materials and methods
Study population
Assessment of exposure and covariates
Ascertainment of hospitalized fracture
Measurement of BMD
Statistical analysis
Results
Basic characteristics of study participants
Weight change from age 25 to baseline (kg) | Ptrend | |||||||
---|---|---|---|---|---|---|---|---|
≤ − 5.0 | − 4.9–2.5 | − 2.4–2.4 | 2.5–4.9 | 5.0–9.9 | 10.0–14.9 | ≥ 15.0 | ||
Participants (n (%)) | 53,658 (13.0) | 31,598 (7.7) | 85,757 (20.8) | 45,717 (11.1) | 84,370 (20.5) | 57,934 (14.1) | 52,778 (12.8) | |
BMI and weight change (mean (SD)) | ||||||||
BMI at age 25* (kg/m2) | 24.3 (2.6) | 22.9 (2.3) | 22.1 (2.3) | 21.7 (2.3) | 21.4 (2.2) | 21.1 (2.2) | 20.5 (2.3) | < 0.001 |
BMI at baseline (kg/m2) | 20.6 (2.4) | 21.4 (2.3) | 22.1 (2.4) | 23.2 (2.3) | 24.3 (2.3) | 25.8 (2.3) | 28.3 (2.9) | < 0.001 |
Weight change (kg) | − 9.0 (3.8) | − 3.6 (0.7) | 0.1 (1.4) | 3.7 (0.7) | 7.4 (1.4) | 12.2 (1.4) | 20.4 (5.1) | < 0.001 |
Demographic and socioeconomic characteristics | ||||||||
Age (year (SD)) | 55.6 (10.7) | 51.6 (10.6) | 49.6 (10.5) | 49.0 (10.2) | 49.5 (9.9) | 50.4 (9.8) | 51.4 (9.8) | < 0.001 |
Women (%) | 49.5 | 54.6 | 58.8 | 63.1 | 61.8 | 57.7 | 52.9 | < 0.001 |
Urban area (%) | 34.2 | 37.0 | 40.6 | 46.9 | 51.7 | 57.7 | 64.1 | < 0.001 |
Middle school or above (%) | 50.0 | 50.9 | 53.0 | 55.1 | 55.7 | 56.1 | 55.6 | < 0.001 |
Married (%) | 89.8 | 90.9 | 91.1 | 91.7 | 92.2 | 92.5 | 92.8 | < 0.001 |
Agricultural and industrial worker (%) | 62.1 | 60.2 | 58.2 | 55.4 | 53.2 | 50.6 | 47.6 | < 0.001 |
Household income ≥ 10,000 RMB/year (%) | 70.9 | 72.5 | 74.0 | 75.8 | 76.9 | 77.9 | 78.6 | < 0.001 |
Lifestyle factors | ||||||||
Male current smoker† (%) | 77.7 | 73.0 | 69.2 | 66.1 | 63.3 | 62.1 | 61.3 | < 0.001 |
Female current smoker† (%) | 4.2 | 2.9 | 2.4 | 2.1 | 2.2 | 2.3 | 2.5 | <0.001 |
Male daily alcohol drinker (%) | 22.5 | 23.0 | 22.6 | 22.4 | 20.9 | 20.2 | 19.1 | < 0.001 |
Female daily alcohol drinker (%) | 1.1 | 1.0 | 1.0 | 0.9 | 0.9 | 1.0 | 0.9 | 0.023 |
Physical activity, MET-hour/day | 22.3 | 22.5 | 22.0 | 21.5 | 21.1 | 20.5 | 19.6 | < 0.001 |
Dairy product consumption more than once per week (%) | 21.4 | 21.6 | 22.2 | 23.1 | 23.1 | 22.6 | 21.6 | 0.145 |
Calcium, iron, or zinc supplementation (%) | 6.4 | 6.6 | 6.7 | 7.1 | 7.3 | 7.8 | 8.1 | < 0.001 |
Self-reported conditions (%) | ||||||||
Diabetes | 5.9 | 4.8 | 4.5 | 4.7 | 5.3 | 6.4 | 8.1 | < 0.001 |
COPD | 9.4 | 7.5 | 6.7 | 6.4 | 5.9 | 5.8 | 5.5 | < 0.001 |
Self-rated poor health (%) | 14.1 | 10.5 | 8.7 | 8.0 | 8.0 | 8.7 | 9.8 | < 0.001 |
Male height (m) | 1.6 | 1.6 | 1.6 | 1.7 | 1.7 | 1.7 | 1.7 | < 0.001 |
Female height (m) | 1.5 | 1.5 | 1.5 | 1.5 | 1.5 | 1.6 | 1.6 | < 0.001 |
Postmenopausal women (%) | 51.6 | 49.8 | 49.4 | 48.6 | 48.4 | 48.4 | 48.1 | < 0.001 |
Weight loss and hospitalized fracture risk
Weight change from age 25 to baseline (kg) | Ptrend | ||||||||
---|---|---|---|---|---|---|---|---|---|
≤ − 5.0 | − 4.9–2.5 | − 2.4–2.4 | 2.5–4.9 | 5.0–9.9 | 10.0–14.9 | ≥ 15.0 | |||
Any fracture | |||||||||
No. of cases | 13,065 | 2357 | 1182 | 2768 | 1366 | 2426 | 1596 | 1370 | |
Cases/PYs (1/1000) | 3.21 | 4.64 | 3.80 | 3.26 | 2.99 | 2.88 | 2.77 | 2.62 | |
Model 1 | 1.10 (1.04, 1.17) | 1.03 (0.96, 1.10) | 1.00 | 0.99 (0.92, 1.05) | 0.98 (0.92, 1.03) | 0.96 (0.90, 1.02) | 0.97 (0.91, 1.04) | < 0.001 | |
Model 2 | 1.07 (1.01, 1.13) | 1.01 (0.95, 1.09) | 1.00 | 0.99 (0.93, 1.06) | 0.98 (0.93, 1.04) | 0.97 (0.91, 1.03) | 0.97 (0.90, 1.03) | < 0.001 | |
Model 3 | 1.07 (1.01, 1.14) | 1.02 (0.95, 1.09) | 1.00 | 0.99 (0.93, 1.06) | 0.98 (0.93, 1.04) | 0.96 (0.91, 1.03) | 0.96 (0.90, 1.03) | 0.003 | |
Upper limb fracture | |||||||||
No. of cases | 3411 | 567 | 294 | 763 | 386 | 636 | 414 | 351 | |
Cases/PYs (1/1000) | 0.83 | 1.10 | 0.93 | 0.89 | 0.84 | 0.75 | 0.71 | 0.67 | |
Model 1 | 0.98 (0.87, 1.09) | 0.91 (0.80, 1.04) | 1.00 | 1.00 (0.89, 1.13) | 0.93 (0.84, 1.03) | 0.92 (0.81, 1.04) | 0.97 (0.85, 1.10) | 0.588 | |
Model 2 | 0.95 (0.85, 1.06) | 0.90 (0.79, 1.03) | 1.00 | 1.01 (0.89, 1.14) | 0.94 (0.85, 1.05) | 0.93 (0.83, 1.05) | 0.99 (0.87, 1.13) | 0.745 | |
Model 3 | 0.92 (0.82, 1.03) | 0.89 (0.78, 1.02) | 1.00 | 1.01 (0.90, 1.15) | 0.96 (0.86, 1.06) | 0.95 (0.84, 1.08) | 1.02 (0.89, 1.17) | 0.285 | |
Lower limb fracture | |||||||||
No. of cases | 3640 | 667 | 352 | 784 | 344 | 660 | 457 | 376 | |
Cases/PYs (1/1000) | 0.89 | 1.29 | 1.12 | 0.91 | 0.75 | 0.78 | 0.79 | 0.71 | |
Model 1 | 1.11 (1.00, 1.24) | 1.07 (0.94, 1.21) | 1.00 | 0.88 (0.77, 1.00) | 0.95 (0.85, 1.05) | 0.99 (0.88, 1.11) | 0.98 (0.86, 1.11) | 0.015 | |
Model 2 | 1.08 (0.98, 1.21) | 1.06 (0.94, 1.20) | 1.00 | 0.88 (0.78, 1.00) | 0.95 (0.86, 1.05) | 0.98 (0.87, 1.10) | 0.95 (0.83, 1.08) | 0.018 | |
Model 3 | 1.10 (0.99, 1.23) | 1.07 (0.94, 1.21) | 1.00 | 0.88 (0.77, 1.00) | 0.94 (0.85, 1.05) | 0.97 (0.86, 1.10) | 0.93 (0.82, 1.06) | 0.013 | |
Spine fracture | |||||||||
No. of cases | 1973 | 311 | 172 | 369 | 221 | 376 | 282 | 242 | |
Cases/PYs (1/1000) | 0.48 | 0.60 | 0.55 | 0.43 | 0.48 | 0.44 | 0.48 | 0.46 | |
Model 1 | 0.98 (0.84, 1.15) | 1.08 (0.90, 1.29) | 1.00 | 1.18 (1.00, 1.39) | 1.07 (0.93, 1.24) | 1.16 (0.99, 1.36) | 1.15 (0.98, 1.36) | 0.029 | |
Model 2 | 0.95 (0.82, 1.11) | 1.06 (0.89, 1.27) | 1.00 | 1.19 (1.00, 1.40) | 1.09 (0.94, 1.26) | 1.18 (1.01, 1.38) | 1.17 (0.99, 1.38) | 0.006 | |
Model 3 | 0.98 (0.84, 1.15) | 1.07 (0.89, 1.29) | 1.00 | 1.18 (1.00, 1.39) | 1.08 (0.93, 1.25) | 1.16 (0.99, 1.36) | 1.14 (0.96, 1.35) | 0.071 | |
Pelvis fracture | |||||||||
No. of cases | 229 | 35 | 34 | 51 | 28 | 47 | 20 | 14 | |
Cases/PYs (1/1000) | 0.06 | 0.07 | 0.11 | 0.06 | 0.06 | 0.06 | 0.03 | 0.03 | |
Model 1 | 0.89 (0.57, 1.37) | 1.56 (1.01, 2.41) | 1.00 | 1.12 (0.70, 1.77) | 1.10 (0.74, 1.64) | 0.75 (0.45, 1.26) | 0.70 (0.39, 1.28) | 0.166 | |
Model 2 | 0.83 (0.54, 1.30) | 1.53 (0.99, 2.36) | 1.00 | 1.12 (0.71, 1.78) | 1.10 (0.74, 1.64) | 0.75 (0.44, 1.26) | 0.67 (0.37, 1.22) | 0.215 | |
Model 3 | 0.90 (0.57, 1.42) | 1.57 (1.01, 2.43) | 1.00 | 1.10 (0.70, 1.75) | 1.07 (0.72, 1.60) | 0.71 (0.42, 1.21) | 0.62 (0.34, 1.15) | 0.079 | |
Hip fracture | |||||||||
No. of cases | 1222 | 337 | 115 | 248 | 105 | 180 | 115 | 122 | |
Cases/PYs (1/1000) | 0.30 | 0.65 | 0.36 | 0.29 | 0.23 | 0.21 | 0.20 | 0.23 | |
Model 1 | 1.35 (1.14, 1.59) | 1.04 (0.83, 1.29) | 1.00 | 0.85 (0.68, 1.07) | 0.76 (0.62, 0.92) | 0.67 (0.54, 0.84) | 0.74 (0.59, 0.92) | < 0.001 | |
Model 2 | 1.32 (1.11, 1.56) | 1.03 (0.82, 1.29) | 1.00 | 0.84 (0.66, 1.05) | 0.73 (0.60, 0.88) | 0.62 (0.49, 0.77) | 0.64 (0.51, 0.80) | < 0.001 | |
Model 3 | 1.39 (1.17, 1.66) | 1.05 (0.84, 1.32) | 1.00 | 0.83 (0.66, 1.04) | 0.71 (0.58, 0.86) | 0.59 (0.47, 0.74) | 0.60 (0.47, 0.75) | < 0.001 | |
Other central body fracture | |||||||||
No. of cases | 1445 | 304 | 150 | 280 | 152 | 263 | 161 | 135 | |
Cases/PYs (1/1000) | 0.35 | 0.59 | 0.48 | 0.33 | 0.33 | 0.31 | 0.28 | 0.26 | |
Model 1 | 1.28 (1.08, 1.50) | 1.20 (0.98, 1.46) | 1.00 | 1.16 (0.95, 1.41) | 1.15 (0.97, 1.36) | 1.07 (0.88, 1.30) | 1.12 (0.91, 1.38) | 0.209 | |
Model 2 | 1.21 (1.03, 1.43) | 1.17 (0.96, 1.43) | 1.00 | 1.18 (0.97, 1.43) | 1.18 (1.00, 1.40) | 1.12 (0.92, 1.36) | 1.18 (0.95, 1.46) | 0.969 | |
Model 3 | 1.16 (0.98, 1.38) | 1.15 (0.94, 1.40) | 1.00 | 1.19 (0.97, 1.44) | 1.20 (1.01, 1.42) | 1.15 (0.94, 1.40) | 1.23 (0.99, 1.52) | 0.418 | |
Other fracture | |||||||||
No. of cases | 2106 | 345 | 160 | 474 | 225 | 436 | 252 | 214 | |
Cases/PYs (1/1000) | 0.51 | 0.67 | 0.51 | 0.55 | 0.49 | 0.51 | 0.43 | 0.40 | |
Model 1 | 1.15 (1.00, 1.33) | 0.92 (0.77, 1.10) | 1.00 | 0.96 (0.82, 1.12) | 1.04 (0.92, 1.19) | 0.93 (0.80, 1.09) | 0.90 (0.76, 1.05) | 0.020 | |
Model 2 | 1.14 (0.99, 1.31) | 0.92 (0.77, 1.10) | 1.00 | 0.96 (0.82, 1.13) | 1.05 (0.92, 1.20) | 0.94 (0.81, 1.10) | 0.89 (0.76, 1.06) | 0.037 | |
Model 3 | 1.14 (0.98, 1.32) | 0.92 (0.77, 1.10) | 1.00 | 0.96 (0.82, 1.13) | 1.05 (0.92, 1.20) | 0.94 (0.80, 1.10) | 0.89 (0.76, 1.06) | 0.060 |
Weight loss and BMD measured at resurvey
Weight change from age 25 to resurvey (kg) | Ptrend | |||||||
---|---|---|---|---|---|---|---|---|
≤ − 5.0 | − 4.9–2.5 | − 2.4–2.4 | 2.5–4.9 | 5.0–9.9 | 10.0–14.9 | ≥ 15.0 | ||
Participants (n (%)) | 2653 (12.4) | 1443 (6.7) | 3950 (18.4) | 2342 (10.9) | 4535 (21.1) | 3370 (15.7) | 3160 (14.7) | |
BUA (dB/MHz) | ||||||||
Model 1 | − 3.54 (− 4.10, − 2.98) | − 1.44 (− 2.11, − 0.77) | 0.00 | 0.77 (0.20, 1.34) | 1.82 (1.34, 2.30) | 2.16 (1.64, 2.68) | 3.18 (2.65, 3.71) | < 0.001 |
Model 2 | − 3.28 (− 3.84, − 2.73) | − 1.38 (− 2.05, − 0.71) | 0.00 | 0.67 (0.11, 1.24) | 1.59 (1.11, 2.06) | 1.86 (1.34, 2.37) | 2.80 (2.26, 3.33) | < 0.001 |
Model 3 | − 4.52 (− 5.08, − 3.96) | − 1.83 (− 2.49, − 1.16) | 0.00 | 1.02 (0.46, 1.59) | 2.13 (1.65, 2.60) | 2.70 (2.18, 3.22) | 4.09 (3.54, 4.63) | < 0.001 |
SOS (m/s) | ||||||||
Model 1 | − 4.67 (− 6.77, − 2.56) | − 0.83 (− 3.38, 1.71) | 0.00 | − 0.09 (− 2.25, 2.06) | 2.55 (0.74, 4.35) | 0.12 (−1.84, 2.07) | 0.28 (−1.72, 2.29) | < 0.001 |
Model 2 | − 3.95 (− 6.05, − 1.84) | − 0.71 (− 3.24, 1.83) | 0.00 | − 0.00 (− 2.15, 2.15) | 2.59 (0.79, 4.39) | 0.33 (−1.62, 2.29) | 1.33 (−0.71, 3.36) | < 0.001 |
Model 3 | − 4.83 (− 6.98, − 2.67) | − 1.02 (− 3.56, 1.52) | 0.00 | 0.25 (− 1.91, 2.40) | 2.97 (1.16, 4.78) | 0.93 (−1.04, 2.91) | 2.24 (0.15, 4.33) | < 0.001 |
SI | ||||||||
Model 1 | − 3.66 (− 4.51, − 2.81) | − 1.19 (− 2.22, − 0.16) | 0.00 | 0.49 (− 0.38, 1.36) | 1.92 (1.19, 2.65) | 1.47 (0.69, 2.26) | 2.20 (1.39, 3.01) | < 0.001 |
Model 2 | − 3.29 (− 4.13, − 2.44) | − 1.12 (− 2.14, − 0.10) | 0.00 | 0.45 (− 0.42, 1.32) | 1.78 (1.05, 2.50) | 1.33 (0.54, 2.12) | 2.23 (1.41, 3.05) | < 0.001 |
Model 3 | − 4.36 (− 5.22, − 3.49) | − 1.50 (− 2.52, − 0.48) | 0.00 | 0.75 (− 0.11, 1.62) | 2.24 (1.51, 2.97) | 2.06 (1.27, 2.86) | 3.35 (2.51, 4.19) | < 0.001 |
Weight change (kg) | Ptrend | |||||||
---|---|---|---|---|---|---|---|---|
≤ − 5.0 | − 4.9–2.5 | − 2.4–2.4 | 2.5–4.9 | 5.0–9.9* | 10.0–14.9* | ≥ 15.0* | ||
Participants (n (%)) | ||||||||
Age 25 → baseline | 2682 (12.5) | 1780 (8.3) | 4557 (21.2) | 2496 (11.6) | 4389 (20.5) | 2941 (13.7) | 2608 (12.2) | |
Baseline → resurvey | 1575 (7.3) | 2552 (11.9) | 10,308 (48.0) | 3909 (18.2) | 3109 (14.5) | -- | -- | |
BUA (dB/MHz) | ||||||||
Age 25 → baseline | − 3.80 (− 4.35, − 3.25) | − 1.32 (− 1.93, − 0.72) | 0.00 | 1.34 (0.80, 1.87) | 2.24 (1.78, 2.70) | 2.87 (2.35, 3.39) | 4.74 (4.17, 5.30) | < 0.001 |
Baseline → resurvey | − 2.01 (− 2.61, − 1.41) | − 0.62 (− 1.10, − 0.14) | 0.00 | 0.84 (0.43, 1.24) | 0.72 (0.27, 1.17) | -- | -- | < 0.001 |
SOS (m/s) | ||||||||
Age 25 → baseline | − 6.19 (− 8.29, − 4.08) | − 2.36 (− 4.67, − 0.05) | 0.00 | 1.26 (− 0.79, 3.31) | 3.11 (1.35, 4.87) | 2.28 (0.28, 4.28) | 3.82 (1.65, 5.98) | < 0.001 |
Baseline → resurvey | 1.26 (− 1.04, 3.56) | − 0.05 (− 1.89, 1.78) | 0.00 | 0.26 (− 1.30, 1.82) | − 2.63 (− 4.35, − 0.91) | -- | -- | 0.010 |
SI | ||||||||
Age 25 → baseline | − 4.25 (− 5.10, − 3.41) | − 1.54 (− 2.46, − 0.61) | 0.00 | 1.24 (0.42, 2.07) | 2.35 (1.65, 3.06) | 2.55 (1.74, 3.35) | 4.22 (3.35, 5.09) | < 0.001 |
Baseline → resurvey | − 0.99 (− 1.92, − 0.07) | − 0.43 (− 1.16, 0.31) | 0.00 | 0.63 (0.00, 1.26) | − 0.25 (− 0.94, 0.44) | -- | -- | 0.056 |