Obesity and risk of fracture in postmenopausal women: a meta-analysis of cohort studies

Figures & data

Figure 1. Studies screening process.

Table 1. Basic characteristics of the included cohorts.

Author	Year	Country	History of fracture	Sample size	Fracture Number	Mean follow-up years	Diagnostic criteria	Baseline BMI	Age	Fracture type	Effect size	Confounders adjusted	NOS scores
Charles	2022	Belgium	None	3560	/	9.1	WHO standards	26.4 ± 4.4	60–85	Ankle and pelvic fractures	OR	Intake of calcium/vitamin D supplements and pharmacological treatment for osteoporosis.	8
Rikkonen	2021	Finland	None	12,715	427	25	WHO standards/ICD-10	26.7 ± 4.4	58–83	Hip fracture	HR	Age, bone density.	6
Kim	2021	Korea	None	383,498	38,006	8.35	ICD-10	24.19 ± 3.16	57.06 ± 8.29	Vertebral fracture	HR	Age, smoking status, alcohol intake, income, regular exercise, and so on.	8
Li	2020	China	None	3985	200	5	WHO standards	27.7 ± 5.7	69.4 ± 8.9	Osteoporotic fracture	HR	Age, smoking, drinking, education, prior falls and fractures, and so on.	7
Tanaka	2013	Japan	None	1614	254	6.7	WHO standards	27.2 ± 2.4	63.2 ± 10.1	Osteoporotic fracture	RR	Age, diabetes mellitus, prior fracture, bone mineral density, back pain, and treatment	6
Alhambra	2012	Spain	None	263,563	/	2.7	WHO BMI categories/ICD-10	/	66.9 ± 12.1	Different skeletal sites fracture	RR	Age	5
Pirro	2010	Italy	None	362	112	/	WHO BMI categories	26.5 ± 4.6	68 ± 8	Vertebral fracture	OR	Age, weight, height or BMI, smoking, early menopause, family history of fragility fractures, and BMD.	6
Gnudi	2009	Italy	None	2235	209	3	/	25.4 ± 4.0	67.9 ± 9.3	Humerus fractures	OR	Age, age at menopause and FN BMD	6

ICD: International Classification of Diseases; /: no report; OR: odds ratio; RR: relative risk; HR: hazard ratio.

Figure 2. Meta-analysis of the risk of all-cause fracture caused by obesity.

Figure 3. Sensitivity analysis of the risk of fracture caused by obesity.

Table 2. Subgroup analysis for the risk of fracture caused by obesity.

Fracture sites	Included studies	RR (95% CI)	Heterogeneity
			I^2	p-value
Hip fracture	3[21,25,27]	1.031 (0.780–1.363)	91.0%	.830
Vertebral fracture	3[22,24,26]	1.154 (1.020–1.305)	94.5%	.023
Pelvic fractures	2[20,25]	0.575 (0.470–0.702)	0.0%	.000
Humerus fracture	2[25,27]	1.139 (0.972–1.334)	58.9%	.107

Figure 4. Publication bias of the risk of fracture caused by obesity.

Table A1. PubMed.

No.	Content	Result
#1	Search: ‘Obesity’[Mesh] Sort by: Most Recent	241,777
#2	Search: (Obesity[Title/Abstract]) OR (Obese[Title/Abstract]) Sort by: Most Recent	350,295
#3	Search: (‘Obesity’[Mesh]) OR ((Obesity[Title/Abstract]) OR (Obese[Title/Abstract])) Sort by: Most Recent	401,510
#4	Search: ‘Fractures, Bone’[Mesh] Sort by: Most Recent	199,228
#5	Search: (Broken*[Title/Abstract]) OR (Fracture*[Title/Abstract]) Sort by: Most Recent	315,608
#6	Search: (‘Fractures, Bone’[Mesh]) OR ((Broken*[Title/Abstract]) OR (Fracture*[Title/Abstract])) Sort by: Most Recent	357,369
#7	Search: ‘Postmenopause’[Mesh] Sort by: Most Recent	26,697
#8	Search: ((Postmenopausal*[Title/Abstract]) OR (Post-Menopause[Title/Abstract])) OR (Post Menopause[Title/Abstract]) Sort by: Most Recent	64,984
#9	Search: (‘Postmenopause’[Mesh]) OR (((Postmenopausal*[Title/Abstract]) OR (Post-Menopause[Title/Abstract])) OR (Post Menopause[Title/Abstract])) Sort by: Most Recent	69,014
#10	Search: (((‘Obesity’[Mesh]) OR ((Obesity[Title/Abstract]) OR (Obese[Title/Abstract]))) AND ((‘Fractures, Bone’[Mesh]) OR ((Broken*[Title/Abstract]) OR (Fracture*[Title/Abstract])))) AND ((‘Postmenopause’[Mesh]) OR (((Postmenopausal*[Title/Abstract]) OR (Post-Menopause[Title/Abstract])) OR (Post Menopause[Title/Abstract]))) Sort by: Most Recent	191

Table A2. Embase.

No.	Content	Result
#1	‘obesity’/mj	202,309
#2	‘obesity’/exp OR obesity OR obese:ab,ti	741,908
#3	#1 OR #2	741,908
#4	‘fracture’/mj	42,789
#5	broken* OR fracture*:ab,ti	382,550
#6	#4 OR #5	389,884
#7	‘postmenopause’/exp/mj	24,921
#8	postmenopausal* OR ‘post menopause’:ab,ti	94,895
#9	#7 OR #8	96,840
#10	#3 AND #6 AND #9	450

Table A3. Cochran Library.

No.	Content	Result
#1	MeSH descriptor: [Obesity] this term only	12,746
#2	(Obesity):ti,ab,kw OR (Obese):ti,ab,kw	47,170
#3	#1 or #2	47,170
#4	MeSH descriptor: [Fractures, Bone] this term only	2411
#5	MeSH descriptor: [Fractures, Bone] this term only	26,316
#6	#4 or #5	26,316
#7	MeSH descriptor: [Postmenopause] this term only	4924
#8	(Postmenopausal*):ti,ab,kw OR (Post-Menopause):ti,ab,kw OR (Post Menopause):ti,ab,kw	22,064
#9	#7 or #8	22,317
#10	#3 and #6 and #9	32

Table A4. Web of science.

No.	Content	Result
#1	(TS = (Obesity)) OR TS = (Obese)	478,833
#2	((TS = (Bone Fractures)) OR TS = (Broken*)) OR TS = (Fracture*)	664,841
#3	(((TS = (Postmenopause)) OR TS = (Postmenopausal*)) OR TS = (Post-Menopause)) OR TS = (Post Menopause)	98,744
#4	#1 AND #2 AND #3	665

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Data availability statement

All data generated or analyzed during the present study are included in this published article.