Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort



This study aims to investigate the role of obesity and diabetes on bone health in a nation-wide cohort of women with high risk of fracture.


The role of obesity and diabetes on fracture risk is yet poorly understood. Body mass index (BMI) and bone mineral density (BMD) are strongly correlated; however, patients with elevated BMI are not protected against fractures, configuring the obesity paradox. A similar controversial association has been also found in diabetic patients. Herein, we present a retrospective analysis on 59,950 women.


Using a new web-based fracture risk-assessment tool, we have collected demographic (including BMI), densitometric, and clinical data (including history of vertebral or hip and non-vertebral, non-hip fractures, presence of comorbidities). We performed a propensity score generation with 1:1 matching for patients in the obese (BMI ≥ 30) and non-obese (BMI < 30) groups, in the diabetics and non-diabetics. Propensity score estimates were estimated using a logistic regression model derived from the clinical variables: age, lumbar spine T-score, and femoral neck T-score.


We found an association between diabetes and fractures of any kind (OR 1.3, 95% CI 1.1–1.4 and 1.3, 95% CI 1.2–1.5 for vertebral or hip fractures and non-vertebral, non-hip fractures, respectively). Obesity, on the other hand, was significantly associated only with non-vertebral, non-hip fractures (OR 1.3, 95% CI 1.1–1.6). To estimate the individual effect of obesity and diabetes on bone health, we ran sensitivity analyses which included obese non-diabetic patients and non-obese diabetic patients, respectively.


Non-obese diabetics had the highest risk of vertebral or hip fracture, whereas obese non-diabetics predominantly had non-vertebral, non-hip fracture’s risk. These results should raise awareness in clinical practice when evaluating diabetic and/or obese patients.

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Corresponding author

Correspondence to G. Adami.

Ethics declarations

The study was conducted according to the protocol 1876 approved by our local Ethics Committee, in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was waived because encrypted retrospective information was used.

Conflicts of interest

Maurizio Rossini reports personal fees from AbbVie, Abiogen, Eli-Lilly, Merck Sharp & Dohme, Novartis, Sanofi, UCB, outside the submitted work. Giovanni Adami, Davide Gatti, Giovanni Orsolini, Francesco Pollastri, Eugenia Bertoldo, Ombretta Viapiana, Francesco Bertoldo, Alessandro Giollo, and Davide Gatti have no conflict of interest to declare.

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Adami, G., Gatti, D., Rossini, M. et al. Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort. Osteoporos Int (2020). https://doi.org/10.1007/s00198-020-05519-5

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  • Body mass index (BMI)
  • Diabetes
  • Fractures
  • Obesity
  • Osteoporosis