Effect of BMI-Discordant Abdominal Tissue Thickness on Fracture Probability: A Registry-Based Study.

FRAX®, which is used to assess fracture probability, considers body mass index (BMI) but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by DXA and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (< -2 cm, -2 to -1 cm) to higher (1 to 2 cm, > +2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (HR 1.23, 95% CI 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects prior to age 65 years (HR 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes there was also increased risk for those in the lowest ATI category (HR 1.73, 95% CI 1.12-2.65 for MOF, 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not seen in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. This article is protected by copyright. All rights reserved.