Abstract
BACKGROUND CONTEXT
Being underweight is a known risk factor for osteoporosis and sarcopenia that is strongly
associated with vertebral fractures, particularly in the elderly. Being underweight
can accelerate bone loss, contribute to impaired coordination, and increase fall risk
in the elderly and the general population.
PURPOSE
This study aimed to identify the degree of underweight as a risk factor for vertebral
fractures in the South Korean population.
STUDY DESIGN
Retrospective cohort study based on national health insurance database.
PATIENT SAMPLE
Participants were included from nationwide regular health check-ups conducted by the
Korean National Health Insurance Service in 2009. Participants were followed up from
2010 to 2018 to identify the incidence of newly developed fractures.
OUTCOME MEASURES
The incidence rate (IR) was defined as the incident per 1,000 person-years (PY). Vertebral
fracture development risk was analyzed using Cox proportional regression analysis.
Subgroup analysis was performed based on several factors, including age, sex, smoking
status, alcohol consumption, physical activity, and household income.
METHODS
Based on body mass index, the study population was categorized into normal weight
(18.50–22.99 kg/m2), mild underweight (17.50–18.49 kg/m2), moderate underweight (16.50–17.49 kg/m2), and severe underweight (<16.50 kg/m2) groups. Cox proportional hazards analyses were performed to calculate the hazard
ratios for vertebral fractures based on the degree of underweight with respect to
normal weight to identify the associated risk.
RESULTS
This study evaluated 962,533 eligible participants, of whom 907,484 were classified
as normal weight, 36,283 as mild underweight, 13,071 as moderate underweight, and
5,695 as severe underweight. The adjusted hazard ratio of vertebral fractures increased
as the degree of underweight increased. Severe underweight was associated with a higher
likelihood of vertebral fracture. The adjusted hazard ratio was 1.11 (95% confidence
interval [CI], 1.04–1.17) in the mild underweight group, 1.15 (1.06–1.25) in the moderate
underweight group, and 1.26 (1.14–1.40) in the severe underweight group when compared
with the normal weight group.
CONCLUSIONS
Underweight is a risk factor for vertebral fractures in the general population. Furthermore,
severe underweight was associated with a higher risk of vertebral fractures, even
after adjustment for other factors. Clinicians could provide real-world evidence that
being underweight carries the risk of vertebral fractures.
Keywords
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Article info
Publication history
Published online: March 01, 2023
Accepted:
February 14,
2023
Received in revised form:
February 13,
2023
Received:
September 6,
2022
Footnotes
FDA device/drug status: Not applicable.
Author disclosures: JP: Nothing to disclose. SH: Nothing to disclose. H-DJ: Nothing to disclose. GS: Nothing to disclose. KH: Nothing to disclose. J-YH: Nothing to disclose.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
