ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2021
Survival bias may explain the appearance of the obesity paradox in hip fracture patients.
Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 3 of them syntheses that pooled it.
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10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 18 citations in OpenAlex.
- Obesity and risk of fracture in postmenopausal women: a meta-analysis of cohort studies.Annals of medicine · 2023Pooled it
- Pooled it
- The impact of body mass index on mortality rates of hip fracture patients: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2022Pooled it
- Explainable machine learning-driven models for predicting Parkinson's disease and its prognosis: obesity patterns associations and models development using NHANES 1999-2018 data.Lipids in health and disease · 2025Article
- Preoperative Indicators for 1-year Mortality in Elderly Individuals Following Hip Fracture Surgery Under A Multidisciplinary Team Co-Management Model: A Single-Centre Retrospective Observational Study.Geriatric orthopaedic surgery & rehabilitation · 2025Article
- Body fat percentage and the outcomes of hip fractures in adults aged 50 years and above: a 1-year follow-up study.Frontiers in medicine · 2025Article
- Obesity classification predicts early complications and mortality after acetabular fracture.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2024Article
- The Impact of Triglyceride-Glucose Index Levels During Perioperative Period on Outcomes in Femoral Neck Fracture Patients.Geriatric orthopaedic surgery & rehabilitation · 2024Article
- Does the "Obesity Paradox" Have an Expiration Date? A Retrospective Cohort Study.Journal of clinical medicine · 2023Article
- The Role of Smoking and Body Mass Index in Mortality Risk Assessment for Geriatric Hip Fracture Patients.Cureus · 2022Article
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6 authors at 2 institutions in 1 country.
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Abstract
Patients with low-energy hip fractures do not follow the obesity paradox as previously reported. In datasets where injury mechanism is not available, the use of age >50 years (as opposed to commonly used >65 years) as a surrogate for a low-energy hip fracture patients may be a more robust inclusion criterion. PURPOSE: In elderly patients with a hip fracture, limited data suggests that obese patients counterintuitively have improved survival compared to normal-weight patients. This "obesity paradox" may be the byproduct of selection bias. We hypothesized that the obesity paradox would not apply to elderly hip fracture patients.
methodsThe National Surgical Quality Improvement Project dataset identified 71,685 hip fracture patients ≥50 years-of-age with complete body mass index (BMI) data that underwent surgery. Patients were stratified into under and over 75-year-old cohorts (n=18,956 and 52,729, respectively). Within each age group, patients were stratified by BMI class and compared with respect to preoperative characteristics and 30-day mortality. Significant univariate characteristics (p<0.1) were included in multivariate analysis to determine the independent effect of obesity class on 30-day mortality (p<0.05).
resultsMultivariate analysis of <75-year-old patients with class-III obesity were more likely to die within 30-days than similarly aged normal-weight patients (OR 1.91, CI 1.06-3.42, p=0.030). Multivariate analysis of ≥75-year-old overweight (OR 0.69, CI 0.62-0.77, p<0.001), class-I obese (OR 0.62, CI 0.51-0.74, p<0.001), or class-II obese (OR=0.69, CI 0.50-0.95, p=0.022) patients were less likely to die within 30-days when compared to similarly aged normal-weight patients.
conclusionsOur data suggest that obesity is a risk factor for mortality in low-energy hip fracture patients, but the appearance of the "obesity paradox" in elderly hip fracture patients results from statistical bias that is only evident upon subgroup analysis.
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