ECTS Abstracts (2015) 1 OC4.1

Unintentional weight loss and fracture: the global longitudinal study of osteoporosis in women

Juliet Compston1, Allison Wyman2, Stephen Gehlbach2, Nelson Watts3, Ethel Siris4, J Coen Netelenbos5, Adolfo Díez-Perez6, Cyrus Cooper7, Roland Chapurlat8, Silvano Adami9, Jonathan Adachi10 & Gordon FitzGerald2


1Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2Center for Outcomes Research, University of Massachusetts Medical School, Worcester, Massachusetts, USA; 3Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio, USA; 4Columbia University Medical Center, New York, New York, USA; 5VU University Medical Center, Amsterdam, The Netherlands; 6Hospital del Mar-IMIM-Autonomous University of Barcelona, Barcelona, Spain; 7University of Southampton, Southampton, UK, 8INSERM UMR 1033, Université de Lyon, Lyon, France; 9University of Verona, Verona, Italy; 10McMaster University, Hamilton, Ontario, Canada.


Background: The adverse effects of weight loss on bone mineral density in postmenopausal women are well documented, and increased risk of distal forearm and hip fractures has been reported in studies with average follow-up periods of around 6 years after weight loss. The aim of this study was to investigate the effects of unintentional weight loss in postmenopausal women on the incidence of clinical fractures at multiple sites in the year following weight loss.

Methods: GLOW is an observational longitudinal study of non-institutionalised women aged ≥55 years recruited from 723 primary physician practices in ten countries. Self-administered questionnaires were mailed and data collected included demographics, medical history, fracture occurrence, medications and weight loss of 10 lb (4.5 kg) or more over the preceding year. Cox models treating weight loss as a time-varying covariate were used to predict fracture in the following survey year, adjusting for factors such as age, prior fracture, co-morbidities, and falls that we have previously shown to be associated with the specific fracture.1

Results: Unintentional weight loss of ≥10 lb during the previous 12 months was reported in Year 2 by 3405 (8.0%) of 42 756 and in Year 3 by 3322 (7.7%) of 43 004 women. After adjustment for clinically relevant variables, a significantly increased risk was seen for hip (HR 1.83, 95% CI 1.25–2.69, P<0.01) and spine fracture (HR 1.46, 95% CI 1.02–2.09, P=0.04) in the year following the unintentional weight loss.

Conclusions: Unintentional weight loss in postmenopausal women is associated with increased risk of hip and spine fracture within the year following weight loss. The rapid time course of this increase in risk has not previously been reported and emphasises the need for prompt fracture risk assessment and appropriate management in women with unintentional bone loss.

Disclosure: The Alliance for Better Bone Health. 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 the National Institute for Health Research (NIHR).

Reference:

1. FitzGerald G et al. J Bone Miner Res 2012 27 1907–15.