Does obesity influence fracture risk? In an interview with HT Lifestyle, Dr Rajesh Srinivas, consultant, orthopedic surgeon, Manipal Hospital Varthur Road and Dr Harekrushna Sahu, consultant, orthopedics and spine surgery, Manipal Hospital Bhubaneswar, spoke about the unexpected obesity and fracture link you might not have considered. Also read | Spine surgeon warns Indians not to ignore back pain until it’s too late, reveals who all ‘should be extra careful’
According to them, maintaining a healthy lifestyle, eating well, and exercising regularly are essential for good bone health and effective weight management, and thereby reducing fracture risk and complications.
What is obesity and what are the global trends?
Dr Srinivas said, “Obesity and fracture risk have a complicated relationship. It was long believed that a person’s bones would be stronger based on their body fat percentage. However, newer research shows that central obesity and abdominal obesity are linked to a higher risk of fractures. Other spinal disorders, like degenerative diseases of the spine and osteoarthritis of the knees and ankles, can worsen in obese individuals.”
Dr Sahu added, “Obesity, defined as a body mass index (BMI) of more than 30 kg/m2, has become more and more prevalent in the last few decades. Obese individuals usually have more fat distribution in the abdomen or waist area. Earlier it was thought that obese individuals have stronger bones due to more body weight and it is protective for some fractures like hip fracture due to cushioning effect of waist fat but recent research suggests that the relationship between obesity and fracture is not that much straight forward and may vary with regards to age, sex, ethnicity and for different fracture types.”
Dr Srinivas further shared that ‘more than 40 percent of adults worldwide are overweight or obese’. “Unfortunately, obesity among children and middle-aged people is rising due to several problems, including metabolic disorders, mainly thyroid issues, growth hormone issues, etc.,” he said.
Factors influencing fracture risk
According to Dr Sahu, many studies have found that obese individuals are more prone to ankle and shoulder fractures as these areas lack the cushioning effect of body fat, and the higher body weight of obese individuals leads to higher impact on these areas during a fall. “Many obese individuals have body posturing and balancing issues, leading to a higher incidence of falls, which can cause fractures,” he said.
Dr Sahu shared that ‘obese individuals usually have lower vitamin D levels in their bodies’, which also impacts bone health and increases fracture risk. “Spine fractures are also very common in many obese individuals, although some studies have contradictory results on this aspect. Many obese individuals have associated metabolic syndrome (diabetes, hypertension, hyperlipidemia), causing difficulty in the management and treatment of their fractures,” he said.
Dr Sahu added, “Recently, due to the increased prevalence of childhood obesity, there has also been an increased risk of some fractures in children. Obese adolescents are also at high risk of developing slipped capital femoral epiphysis, a condition causing the spontaneous slippage of the femoral head of the thigh bone.”
Obesity and bone health in women
Women, who face obesity after menopause, encounter significant challenges due to osteoporosis, according to Dr Srinivas. He said, “The bones weaken rapidly after menopause, and obesity increases stress on them, leading to a higher risk of hip, spinal, and wrist fractures. Obesity not only raises the chances of fractures but also slows down recovery.”
Dr Sahu said that obese post-menopausal women have also been associated with osteoporosis, defined as decreased bone mineral density, causing weak bones that easily fracture during a fall.
Importance of lifestyle modifications
Dr Srinivas said that efforts to combat obesity primarily focus on figuring out its causes, whether they are metabolic, genetic, or related to diet: “We need to find the root cause and address it directly. Managing obesity requires teamwork. We also involve an endocrinologist to assess and address the issue. Our main goal is to prevent obesity, with lifestyle being the key factor.”
According to the WHO, a person needs to walk briskly for 40 to 45 minutes to stay healthy. Dr Srinivas said, “This is in addition to doing exercises or workouts like strength training. It’s important to track calorie intake and calorie loss, as this provides a clear way to manage one’s lifestyle. We should also understand lifestyle changes well. These changes mainly focus on keeping a daily exercise routine and eating a healthy diet.”
Dr Sahu said fractures in obese individuals are challenging to treat surgically because of weak bones, more fat, and possible postoperative wound complications. “Rehabilitation after surgically or conservatively treated fractures in obese individuals can also be problematic due to high body weight and balancing issues, sometimes leading to prolonged non-weight-bearing status and making them bedridden,” he said.
“There is always a high risk of fracture incidence in obese individuals, which is difficult to manage and rehabilitate, leading to poorer outcomes for many. So it’s always better to prevent getting overweight or obese by regulating our food habits and doing regular exercise. Obese individuals should take adequate vitamin D supplements if they have lower levels and do regular exercise, and should be aware of fall prevention strategies to reduce the incidence of fractures in them,” he added.
Exercise recommendations for obese individuals
Dr Srinivas said, “If the patient is obese, we recommend avoiding activities that put a lot of stress on the body. For example, running or jumping adds significant pressure on the legs and spine. Until they lose weight, we suggest they avoid these activities and switch to low-impact options like cycling, swimming, and walking, which can be increased gradually.”
For elderly patients who are somewhat obese, Dr Srinivas recommended using assistance when walking, such as a stick or a walker, to help prevent falls: “At home, we suggest adding supports in necessary areas and using non-slip clothing, especially in the bathroom, to reduce the risk of falls.”
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
