SynthesisPloS one2021
Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis.
Synthesis in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
108 citing papers in PubMed, 4 syntheses or guidelines pooled it, 152 citations in OpenAlex.
- Feasibility and outcomes of the direct anterior approach in total hip arthroplasty for obese patients: a systematic review.Musculoskeletal surgery · 2026Pooled it
- Machine learning-based risk predictive model for postoperative refractures in patients with osteoporotic vertebral compression fractures: a systematic review and critical appraisal.BMC musculoskeletal disorders · 2026Pooled it
- Obesity and risk of fracture in postmenopausal women: a meta-analysis of cohort studies.Annals of medicine · 2023Pooled it
- Frequency of osteoporosis in Chinese patients with rheumatoid arthritis: a meta-analysis.Archives of osteoporosis · 2023Pooled it
- The Effect of Conjugated Linoleic Acid Supplementation on Densitometric Parameters in Overweight and Obese Women-A Randomised Controlled Trial.Medicina (Kaunas, Lithuania) · 2023Trial
- Glucose metabolism in osteoporosis: A potential therapeutic target (Review).International journal of molecular medicine · 2026Review
- The Obesity-Bone Paradox in Postmenopausal Women: Divergent Associations of BMI with Bone Mineral Density and Trabecular Bone Score in a Real-World DXA Cohort.Medicina (Kaunas, Lithuania) · 2026Observational
- Obesity-related bone fragility: An emerging clinical paradox.The Indian journal of medical research · 2026Article
- Rural-urban differences in osteoporosis and sarcopenia prevalence among Gambian older adults: a pilot study.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2026Article
- Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors.JAMA network open · 2026Article
- Assessment of Osteoporotic Fracture Risk in Patients above 50 Years Using Quantitative Ultrasonography and Fracture Risk Assessment Tool: A Cross-sectional Study.Journal of orthopaedic case reports · 2026Article
- Does body mass index independently affect functional outcomes after conservatively treated distal radius fractures? a retrospective cohort study.BMC musculoskeletal disorders · 2026Article
- Beyond Weight Loss: Skeletal Considerations in Obesity Treatment.Endocrinology and metabolism (Seoul, Korea) · 2026Review
- Impact of splenectomy on fracture risk via the bone-immune axis: A nationwide Korean cohort study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Psychotropic medication use and bone loss in men: longitudinal study.BJPsych open · 2026Article
- The Intimate Relationship between Adipose Tissue, Fertility, and Bone.Journal of frailty, sarcopenia and falls · 2026Review
- Fracture trends in Denmark from 1997 to 2021.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Midlife physical activity, BMI, and hip fracture risk five decades later in men: a NOREPOS study.Archives of osteoporosis · 2026Article
- SHBG and APOA1 as serum biomarkers for low bone mineral density in Mexican postmenopausal women: a random forest-based analysis.Frontiers in endocrinology · 2026Article
- Residential altitude was not independently associated with osteoporosis among long-term Qinghai-Tibetan Plateau residents.Frontiers in public health · 2026Article
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population.
objectivesThis systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques). DATA SOURCES: PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021. DATA SYNTHESIS: Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes.
conclusionsThis meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42020159189.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.