High fracture rates in obesity despite normal bone mineral density

Fortunate Osawemwenze; Elizabeth Nassuna; Donna Rowe; Jacques Abella; Tricia Tan; Jeremy Cox; Comninos Alexander N; Preeshila Behary

doi:10.1530/endoabs.117.OC5.4

OC5.4

Prev Next

Section Contents Cite

Endocrine Abstracts (2026) 117 OC5.4 | DOI: 10.1530/endoabs.117.OC5.4

SFEBES2026 Oral Communications Metabolism, Obesity and Diabetes (6 abstracts)

High fracture rates in obesity despite normal bone mineral density

Fortunate Osawemwenze ¹ , Elizabeth Nassuna ² , Donna Rowe ² , Jacques Abella ² , Tricia Tan ¹ , Jeremy Cox ¹ , Alexander N Comninos ¹ & Preeshila Behary ¹

Author affiliations

¹Imperial College, London, United Kingdom; ²Imperial College NHS Trust, London, United Kingdom

Background: Obesity has been traditionally considered protective against fragility fractures due to associated higher bone mineral density (BMD). However, recent studies challenge this by reporting high fracture rates in obese individuals. Therefore, we comprehensively studied obesity parameters in fragility fracture patients and hypothesised that obesity does not protect against fragility fractures.

Methods: This retrospective observational study included 1,007 patients aged ≥50y with fragility fractures from the Imperial NHS Trust Fracture Liaison Service Database. Primary outcome was obesity prevalence. Secondary outcomes included BMD/T-scores (lumbar spine, femoral neck, total hip) from dual-energy X-ray absorptiometry (DEXA), fracture sites, and comorbidities in obese versus non-obese patients. Body mass index (BMI) was categorised using ethnic-specific cut-offs.

Results: Obesity prevalence (22%) was higher than the London average (20%) (P = 0.03). Obese patients fractured at a younger age than non-obese patients (median 72 vs. 77 years, P < 0.0001), despite normal BMD at total hip and spine (median T-score –0.8 and –0.9 respectively). Obese patients were more likely to experience upper limb fractures (OR 1.47, P < 0.05) and less likely to sustain hip fractures (OR 0.47, P < 0.001). Bone-related comorbidities were more prevalent among obese patients, including type 2 diabetes/prediabetes (50% vs. 35% in non-obese, P = 0.0001).

Discussion/Conclusion: High obesity prevalence and younger fracture age in obese patients suggest obesity does not protect against fragility fractures in this large cohort. These findings highlight obese individuals may have weakened bones despite normal BMD. This may be due to impaired bone quality (not captured by DEXA), driven by multiple factors including comorbidities. Biomechanical factors, such as greater hip padding and higher impact forces on the arms during falls, may explain the predominance of upper limb fractures in obese patients. Fracture risk assessment in obese individuals should consider bone quality, comorbidities, and nutritional factors alongside BMD to better identify those at fracture risk.