SynthesisJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2025
Body mass index and subsequent fracture risk: a meta-analysis to update FRAX.
Abstract readMeta-Analysis
In one paragraph
Synthesis in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
–field-weighted citation impact
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
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Secondary fracture risk after hip fracture in older patients: an updated sex-specific systematic review and meta analysis with GRADE and PAF assessment.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Pooled it
- Predictive value of BMD for hip and other fractures: a meta-analysis to update FRAX.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Pooled it
- Prevalence, risk factors and adverse health outcomes of osteosarcopenia in middle-aged and older adults with type 2 diabetes mellitus-a scoping review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Review
- Management of glucocorticoid-induced osteoporosis in rheumatic diseases.Best practice & research. Clinical rheumatology · 2026Review
- Intramuscular fat infiltration is associated with higher vertebral void space burden and lower volumetric bone mineral density in older adults.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Adiposity Excess and Vertebral Fractures in Patients With Breast Cancer Taking Aromatase Inhibitors.JAMA network open · 2026Article
- Glucagon-Like Peptide-1 Receptor Agonists and Fragility Fracture Risk in Type 2 Diabetes.JAMA network open · 2026Article
- REMS versus DXA in older adults: diagnostic concordance for osteoporosis in a geriatric outpatient population.Archives of osteoporosis · 2026Article
- Spine-hip bone mineral density discordance in postmenopausal Asian women: fracture burden and incremental risk stratification beyond hip BMD.Archives of osteoporosis · 2026Article
- The association between 10-year cardiovascular risk and fracture incidence in postmenopausal women: a prospective analysis from the Women's Health Initiative.Lancet regional health. Americas · 2026Article
- FRAX-based national survey of osteoporotic fracture risk, related knowledge, and associated factors, among Egyptian adults aged 40 years and older, 2025.Scientific reports · 2026Article
- Diet Quality Trajectories and Musculoskeletal Health Among the Oldest Old: Findings from the Hertfordshire Cohort Study.Nutrients · 2026Article
- Article
- Underlying Mechanisms of Osteoporosis in the Context of Multimorbidity: Clinical Challenges and Management Strategies.Nutrients · 2026Review
- Underweight Status is Associated with Prevalent Anemia in Postmenopausal Women with Osteoporotic Vertebral Compression Fractures: A Cross-Sectional Study.Clinical interventions in aging · 2026Article
- Associations between total and regional fat-to-muscle mass ratio and fracture risk in elderly population: a prospective cohort study in UK Biobank.Frontiers in medicine · 2026Article
- Low BMI and postoperative outcomes in elderly hip fracture patients: a Japanese nationwide database study.Journal of bone and mineral metabolism · 2026Article
- Candidate proteomic indirect-effect signals linking dementia to probable muscle-bone fragility: a UK Biobank cohort study.Frontiers in medicine · 2026Article
- Associations of folic acid supplements and dietary folate intake with gestational diabetes mellitus: complementary evidence from a multimethod investigation.Frontiers in nutrition · 2026Article
- A nomogram integrating machine learning with clinical predictors for osteosarcopenia risk prediction in type 2 diabetes mellitus.Frontiers in endocrinology · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
87 authors.
Nicholas C HarveyMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, United Kingdom.ORCID 0000-0002-8194-2512
Helena JohanssonCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.
Eugene V McCloskeyCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.ORCID 0000-0003-0177-8140
Enwu LiuSouth Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.ORCID 0000-0003-2580-3523
Kristina E ÅkessonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.ORCID 0000-0003-3024-2804
Fred A AndersonGLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, United States.
Rafael Azagra-LedesmaDepartment of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Cecilie L BagerNordic Bioscience A/S, Herlev, Denmark.
Charlotte BeaudartPublic Health Aging Research and Epidemiology (PHARE) Group, Research Unit in Clinical Pharmacology and Toxicology (URPC), NAmur Research Institute for LIfe Sciences (NARILIS), Faculty of Medicine, University of Namur, 5000 Namur, Belgium.
Heike A Bischoff-FerrariDepartment of Aging Medicine, Felix Platter, University of Basel, 4055 Basel, Switzerland.
Emmanuel BiverDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.ORCID 0000-0001-6174-1951
Olivier BruyèreResearch Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
Jane A CauleyDepartment of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
Jacqueline R CenterGarvan Institute of Medical Research, Sydney, NSW, Australia.ORCID 0000-0002-5278-4527
Roland ChapurlatINSERM UMR 1033, Université Claude Bernard-Lyon1, Hôpital Edouard Herriot, Lyon, France.
Claus ChristiansenNordic Bioscience A/S, Herlev, Denmark.
Cyrus CooperMRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD, United Kingdom.ORCID 0000-0003-3510-0709
Carolyn J CrandallDivision of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States.ORCID 0000-0001-9441-0198
Steven R CummingsSan Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, United States.
José A P da SilvaCentre for Innovative Biomedicine and Biotechnology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Bess Dawson-HughesBone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States.ORCID 0000-0003-3136-0386
Adolfo Diez-PerezDepartment of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain.
Alyssa B DufourMarcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States.ORCID 0000-0001-8061-9599
John A EismanSt Vincent's Clinical School, School of Medicine and Health, University of New South Wales Sydney, Sydney, NSW, Australia.ORCID 0000-0002-7162-7471
Petra J M EldersDepartment of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Serge FerrariDivision of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.ORCID 0000-0002-1372-4417
Yuki FujitaDepartment of Hygiene and Public Health, Faculty of Medicine, Kansai Medical University, Osaka, Japan.
Saeko FujiwaraDepartment of Pharmacy, Yasuda Women's University, Hiroshima, Japan.
Claus-Christian GlüerSection Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany.
Inbal GoldshteinMaccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.
David GoltzmanDepartment of Medicine, McGill University and McGill University Health Centre, Montreal, QC, Canada.
Vilmundur GudnasonIcelandic Heart Association, Kopavogur, Iceland.
Jill HallMRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom.
Didier HansInterdisciplinary Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.ORCID 0000-0003-1826-5958
Mari HoffDepartment of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
Rosemary J HollickAberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom.
Martijn HuismanDepartment of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
Masayuki IkiDepartment of Public Health, Kindai University Faculty of Medicine, Osaka, Japan.ORCID 0000-0003-2128-5255
Sophia Ish-ShalomEndocrine Clinic, Elisha Hospital, Haifa, Israel.
Graeme JonesMenzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Magnus K KarlssonClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.ORCID 0000-0002-0616-5928
Sundeep KhoslaRobert and Arlene Kogod Center on Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States.ORCID 0000-0002-2936-4372
Douglas P KielDepartment of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.ORCID 0000-0001-8474-0310
Woon-Puay KohHealthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Fjorda KoromaniDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.ORCID 0000-0002-6942-5889
Mark A KotowiczInstitute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.
Heikki KrögerDepartment of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland.
Timothy KwokDepartment of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.ORCID 0000-0001-9253-3549
Olivier LamyCentre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland.ORCID 0000-0001-6512-6008
Arnulf LanghammerHUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Bagher LarijaniEndocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.ORCID 0000-0002-0023-1568
Kurt LippunerARTORG Center for Biomedical Engineering Research, Faculty of Medicine, University of Bern, Bern, Switzerland.
Fiona E A McGuiganClinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden.ORCID 0000-0002-8033-9981
Dan MellströmGeriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Thomas MerlijnDepartment of General Practice, Amsterdam UMC, location AMC, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.ORCID 0000-0003-3003-6488
Tuan V NguyenSchool of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia.
Anna NordströmSchool of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
Peter NordströmDepartment of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
Terence W O'NeillNational Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Barbara Obermayer-PietschDivision of Endocrinology and Diabetology, Department of Internal Medicine, Medical University Graz, Graz, Austria.
Claes OhlssonSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0002-9633-2805
Eric S OrwollDepartment of Medicine, Oregon Health and Science University, Portland, OR, United States.ORCID 0000-0002-8520-7355
Julie A PascoInstitute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, VIC, Australia.
Fernando RivadeneiraDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Berit ScheiDepartment of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
Anne-Marie SchottUniversité Claude Bernard Lyon 1, RESHAPE U INSERM U-1290, Lyon, France.
Eric J ShiromaLaboratory of Epidemiology and Population Sciences, National Institute on Aging, Baltimore, MD, United States.
Kristin SiggeirsdottirIcelandic Heart Association, Kopavogur, Iceland.
Eleanor M SimonsickTranslational Gerontology Branch, National Institute on Aging Intramural Research Program, Baltimore, MD, United States.ORCID 0000-0002-5460-3494
Elisabeth Sornay-RenduINSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.
Reijo SundKuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.ORCID 0000-0002-6268-8117
Karin M A SwartDepartment of General Practice, Amsterdam UMC, location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Pawel SzulcINSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France.ORCID 0000-0003-4168-6697
Junko TamakiDepartment of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan.ORCID 0000-0003-3930-9729
David J TorgersonYork Trials Unit, Department of Health Sciences, University of York, York, United Kingdom.
Natasja M van SchoorDepartment of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit, Amsterdam, The Netherlands.
Tjeerd P van StaaCentre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
Joan VilaStatistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain.
Nicholas J WarehamMRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom.
Nicole C WrightCenter for Health Outcomes, Implementation, and Community-Engaged Sciences, Tulane University, New Orleans, LA, United States.ORCID 0000-0001-8414-4842
Noriko YoshimuraDepartment of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan.
M Carola ZillikensDepartment of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.ORCID 0000-0001-9186-3423
Marta ZwartPRECIOSA-Fundación para la investigación, Barberà del Vallés, Barcelona, Spain.
Liesbeth VandenputSahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Mattias LorentzonSahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.ORCID 0000-0003-0749-1431
William D LeslieDepartment of Medicine, University of Manitoba, Winnipeg, MB, Canada.ORCID 0000-0002-1056-1691
John A KanisCentre for Metabolic Bone Diseases, University of Sheffield, Sheffield, United Kingdom.
Funding
Oregon Clinical and Translational Research Institute - The National COVID Cohort Collaborative (N3C)UL1TR002369 · NCATS · OREGON HEALTH & SCIENCE UNIVERSITY · PI Cynthia D Morris, Christopher G. Slatore · 2017 to 2026
$78.4MWOMEN'S HEALTH INITIATIVE - CLINICAL COORDINATING CENTER: TASK AREA B - LONG LIFE STUDY VISIT 2 LIMITED HOME VISIT75N92021D00001 · NHLBI · FRED HUTCHINSON CANCER RESEARCH CENTER · PI ANDERSON, GARNET L. · 2021 to 2025
$52.0MStudy of Osteoporotic FracturesR01AG005407 · NIA · UNIVERSITY OF CALIFORNIA SAN FRANCISCO · PI CUMMINGS, STEVEN RON, YAFFE, KRISTINE · 1986 to 2016
$23.2MRISK FACTORS FOR VERTEBRAL FRACTURE AND BONE LOSSR01AR041398 · NIAMS · RHODE ISLAND HOSPITAL (PROVIDENCE, RI) · PI KIEL, DOUGLAS P. · 1991 to 2025
$16.1MLong term fracture risk and change in peripheral bone in the oldest old men: The MrOS studyR01AG066671 · NIA · CALIFORNIA PACIFIC MED CTR RES INSTITUTE · PI BOUXSEIN, MARY L, CAWTHON, PEGGY MANNEN · 2020 to 2024
$13.3MOsteoporotic Fractures in Men (MrOS) - San Francisco Coordinating CenterU01AR066160 · NIAMS · CALIFORNIA PACIFIC MED CTR RES INSTITUTE · PI CUMMINGS, STEVEN RON · 2013 to 2017
$9.3MThe Gut Microbiome and Bone MicroarchitectureR01AR061445 · NIAMS · HEBREW REHABILITATION CENTER FOR AGED · PI KIEL, DOUGLAS P. · 2012 to 2021
$8.9MWOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC): TASK AREA A AND A275N92021D00002 · NHLBI · STATE UNIVERSITY OF NEW YORK AT BUFFALO · PI WACTAWSKI-WENDE, JEAN · 2021 to 2025
$6.9MWOMEN'S HEALTH INITIATIVE (WHI) REGIONAL CENTER (RC) - TO EXERCISE OPTION PERIOD ONE (1) AND REVISE CONTRACT ARTICLES.75N92021D00004 · NHLBI · STANFORD UNIVERSITY · PI STEFANICK, MARCIA · 2021 to 2025
$6.5MStudy of Osteoporotic FracturesR01AG005394 · NIA · UNIVERSITY OF MINNESOTA TWIN CITIES · PI ENSRUD, KRISTINE · 1986 to 2015
$6.1MOsteoporotic Fractures in Men (MrOS) - MinneapolisU01AG042145 · NIA · UNIVERSITY OF MINNESOTA · PI ENSRUD, KRISTINE · 2013 to 2019
$5.3MOsteporotic Fractures in Men (MrOS)- Admin CenterU01AG027810 · NIA · OREGON HEALTH & SCIENCE UNIVERSITY · PI ORWOLL, ERIC S. · 2006 to 2017
$5.1MNCATS NIH HHS UL1 TR002369NHLBI NIH HHS 75N92021D00001NHLBI NIH HHS 75N92021D00002NHLBI NIH HHS HHSN268201500001CNHLBI NIH HHS HHSN268201500001INHLBI NIH HHS N01 HC025195NIAMS NIH HHS R01 AR035582NIAMS NIH HHS R01 AR035583NIAMS NIH HHS R01 AR035584NIAMS NIH HHS R01 AR041398NIAMS NIH HHS R01 AR061445NIAMS NIH HHS U01 AR066160NIA NIH HHS R01 AG005394NIA NIH HHS R01 AG005407NIA NIH HHS R01 AG066671NIA NIH HHS U01 AG027810NIA NIH HHS U01 AG042124NIA NIH HHS U01 AG042139NIA NIH HHS U01 AG042140NIA NIH HHS U01 AG042143NIA NIH HHS U01 AG042145NIA NIH HHS U01 AG042168WHI NIH HHS 75N92021D00003WHI NIH HHS 75N92021D00004WHI NIH HHS 75N92021D00005
Abstract
The aim of this international meta-analysis was to quantify the predictive value of BMI for incident fracture and relationship of this risk with age, sex, follow-up time, and BMD. A total of 1 667 922 men and women from 32 countries (63 cohorts), followed for a total of 16.0 million person-years were studied. 293 325 had FN BMD measured (2.2 million person-years follow-up). An extended Poisson model in each cohort was used to investigate relationships between WHO-defined BMI categories (Underweight: <18.5 kg/m2; Normal: 18.5-24.9 kg/m2; Overweight: 25.0-29.9 kg/m2; Obese I: 30.0-34.9 kg/m2; Obese II: ≥35.0 kg/m2) and risk of incident osteoporotic, major osteoporotic and hip fracture (HF). Inverse-variance weighted β-coefficients were used to merge the cohort-specific results. For the subset with BMD available, in models adjusted for age and follow-up time, the hazard ratio (95% CI) for HF comparing underweight with normal weight was 2.35 (2.10-2.60) in women and for men was 2.45 (1.90-3.17). Hip fracture risk was lower in overweight and obese categories compared to normal weight [obese II vs normal: women 0.66 (0.55-0.80); men 0.91 (0.66-1.26)]. Further adjustment for FN BMD T-score attenuated the increased risk associated with underweight [underweight vs normal: women 1.69 (1.47-1.96); men 1.46 (1.00-2.13)]. In these models, the protective effects of overweight and obesity were attenuated, and in both sexes, the direction of association reversed to higher fracture risk in Obese II category [Obese II vs Normal: women 1.24 (0.97-1.58); men 1.70 (1.06-2.75)]. Results were similar for other fracture outcomes. Underweight is a risk factor for fracture in both men and women regardless of adjustment for BMD. However, while overweight/obesity appeared protective in base models, they became risk factors after additional adjustment for FN BMD, particularly in the Obese II category. This effect in the highest BMI categories was of greater magnitude in men than women. These results will inform the second iteration of FRAX®.
Indexed as
Body Mass IndexFractures, BoneOsteoporotic FracturesAgedBone DensityFemaleHumansMaleMiddle AgedRisk FactorsBMIepidemiologyFRAXhip fracturemajor osteoporotic fracturemeta-analysisosteoporosis
Identifiers
What OpenQuestion holds
Textmetadata
LicenceCC BY
Read underepoch 390
Registered trials
None linked
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.