Obesity and the skeleton

On the 12 May 2014, a selection of Fellows and guests gathered to participate in a lively discussion about Professor Juliet Compston’s research on fractures among obese individuals.

Juliet explained how fractures amongst the older generations are a significant health and economic burden, estimated to cost €99 billion across the EU per year, and as society continues to age, these burdens are likely to increase. There are also health concerns about our growing waistlines, with half of the UK population set to become obese by 2050 if current trends continue. As obese individuals will naturally develop a larger skeleton to support their increased size, along with more soft-tissue padding in the event of a fall, it was previously thought that obesity protected against fractures. However, Juliet dispelled this myth with some impressive epidemiological data in post-menopausal women. Despite the underweight demographic being the most at-risk for osteoporotic fractures, Juliet demonstrated that obese women now account for 27% of all fractures. Interestingly, the sites of fractures are also changing - whereas underweight women tend to fracture at their hips, wrist or spine, obese women more commonly present with ankle fractures.

Physicians often estimate the bone mineral density (BMD) of older fracture patients to diagnose osteoporosis. While obese individuals tended to be in the normal BMD range rather than osteoporotic, they discovered that obese individuals who present with fractures had a significantly lower BMD than those who did not fracture, suggesting that BMD still has an important role in fractures of obese patients, but the ranges may require redefining for this population. Juliet pondered whether obese individuals that were unlikely to be prescribed bone treatment medication - especially when compared to their underweight “frail” peers - should in fact require treatment. Juliet emphasised that more research is required to determine how obese individuals respond to treatment, as bisphosphonates are known to be taken up by bone and higher doses might be required for larger skeletons.

This fascinating talk led to a thought provoking discussion over dinner which was chaired by Professor Fiona Karet FMedSci. Points including whether weight leads to the remodelling of load bearing joints such as the ankles, which could explain the increased risk of fracture at that site in obese individuals, and the need for better awareness of ‘elderly-proofing’ houses to prevent unnecessary accidents in the same way people child-proof their homes. Even the potential of fitting those most at-risk with inflating airbags was discussed!

The next discussion dinner will be held on Monday 29 September 2014. Professor Christine Harrison FMedSci, Professor of Childhood Cancer Cytogenetics, will be discussing her research on leukaemia.

Discussion dinners are for Fellows of the Academy and invited guests.

For more information or to book a place, please contact alison.rojo@acmedsci.ac.uk, or visit our website for more information about upcoming events at the Academy.

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