Risk Fractures Obesity Can Cause
Ukandu Israel
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Bone health and obesity have a complicated relationship. A higher body mass index (BMI) might mean stronger bones and lower osteoporosis risk due to increased bone mineral density, a vital element of bone strength.1 On the other hand, obesity can increase your risk for fractures, especially as you get older.2
Osteoporosis is a bone disease that weakens bones and makes it more likely for you to experience a fracture. A fracture is a partial or complete break in the bone.
Research suggests the skeletons of people with obesity are less strong due to the inhibition of new bone cells and bone-regulating hormones responsible for breaking down old tissue and rebuilding it.2 Fat cells might also interfere with the chemical processes that regulate bone health, and visceral fat (abdominal fat) seems to play a significant role in bone loss.
This article will cover the relationship between obesity and fractures, the effect of excess body fat on the bones and joints, prevention and management of fractures, and more.
A healthcare provider examines a person recovering from a fracture
Obesity and Body Mass Index
The term “obesity” describes having too much body fat.3 The commonly used measurement of body fat is body mass index (BMI). It uses a simple calculation based on the ratio of height and weight. BMI is a dated, biased measure that doesn’t account for several factors, such as body composition, ethnicity, race, gender, and age.
Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.4 A higher BMI correlates with risks of heart disease, diabetes, high blood pressure, and certain cancers.
Connection Between Obesity and Fracture Risk
According to the Bone Health & Osteoporosis Foundation (BHOF), some people are at an increased risk for fractures. You could be at risk if you are
Women who are overweight or obese may also be at an increased risk for broken bones. Research presented at the 2022 European Congress on Obesity found women with higher waist circumferences were more vulnerable to fractures than women at a healthy weight.6 However, men who were underweight (not overweight) had a greater risk for fractures.
Verywell Health acknowledges that sex and gender are related concepts, but they are not the same. To accurately reflect our sources, this article uses terms like “female,” “male,” “woman,” and “man,” as its sources do.
According to the American Academy of Orthopaedic Surgeons, children who are overweight or have obesity may also have an increased risk for fractures.7 This might be due to too much stress on the growth plate, which can lead to bone breaks, juvenile arthritis, and other severe bone and joint conditions. Too much weight can also impact childhood bone health and growth.
Studies, including one reported in 2022 in Sports Medicine & Musculoskeletal Disorders, suggest that a higher BMI may not offer protection against all types of fractures, contradicting prior studies.8 These newer studies also note that conditions related to obesity (including type 2 diabetes) may contribute to bone loss and increase fracture risk, including hip and spinal fractures.
Being Underweight and Fracture Risk
Adults over age 40 who are underweight may also be at an increased risk for fractures, according to a 2023 Scientific Reports article.9 That report finds that being underweight is a risk factor for fractures in people over age 40, even if they return to a healthy weight.
According to the International Osteoporosis Foundation, a BMI of 19 kilograms per square meter (kg/m2) is considered underweight.10 People with this low BMI are at a higher risk for osteoporosis and fractures.
Effects on Joints
Your joints are the places in your body where two bones meet.11 They play a vital role in supporting the skeleton and in most of your body's movements. As people age, many health factors lead to arthritic conditions, and having excess weight is a common cause.
According to the Centers for Disease Control and Prevention (CDC), weights higher than what is considered healthy (BMI of 18.5 to 24.9) are described as overweight or having obesity.12 A BMI of 25.0 to 29.9 puts you in the overweight range, while a BMI of 30.0 falls into the obese range.
Excess weight can damage bones and joints by adding physical stress. This is often the case with weight-bearing joints like the back, hips, and knees.
While joint wear and tear is expected as people age, added pressure from excess weight can cause cartilage damage to occur much earlier.
Research has found that people who are overweight are twice as likely to develop knee osteoarthritis, the most common type of osteoarthritis (OA), which is arthritis that develops with age and use.13 People who are considered obese have a 3.1-fold to 4.7-fold increased risk for OA.
Obesity can also affect non-weight-bearing joints, such as the wrists, hands, and fingers. One 2023 Bone Research report finds obesity is not only associated with a mechanical load on joints but also with metabolic abnormalities that lead to OA in non-weight-bearing joints.14
People who are overweight or have obesity might also be at an increased risk for certain types of inflammatory arthritis, like rheumatoid arthritis (RA). RA is an autoimmune disease in which the immune system causes inflammation of the synovial linings of joints and other body systems.
A 2020 Scientific Reports review looked at 13 studies and found three variables were explicitly linked to RA risk: higher BMI in middle age, BMI at age 18, and waist circumference.15 It is also possible to develop RA at a healthy body weight, so much of the research on RA and weight is speculative at best.
Musculoskeletal Pain and Obesity
Obesity is strongly linked to musculoskeletal pain—pain that affects the bones, joints, ligaments, tendons, and muscles. The joints and muscles of the lower body, including the knees, hips, thighs, ankles, and feet, are most often affected.16
Short-Term and Long-Term Risks
Results from a 2017–2018 National Health and Nutrition Examination Survey (NHANES) that relied on height and weight found an estimated 42.5% of U.S. adults over age 20 had obesity, and 9% had severe obesity.17 Weight problems can cause both short- and long-term effects that might be resolved with weight loss. Such short-term risks include:
Long term, obesity can lead to severe health problems, including heart disease, type 2 diabetes, stroke, some cancers, osteoporosis, and osteoarthritis.4 It might also cause osteosarcopenic obesity, a worsening bone density and muscle mass. Osteosarcopenic obesity can, over time, increase your risk for fractures, physical disability, and various poor health outcomes.
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Prevention Steps Before a Fracture With Obesity
A fracture can have severe consequences, especially if you are overweight, an older adult, or have osteoporosis or osteoarthritis.23 A fall can lead to a severe fracture that may require surgical repair, which can make it harder to get around, make daily tasks harder, and even reduce your quality of life.6
Although genetics and medical problems can contribute to weight status, diet and exercise can often help people lose and manage weight.24 Keeping your weight in check might reduce your risk for falls and fractures and improve your health overall. Your healthcare provider can be a helpful resource if you want to lose weight.
You will also want to be mindful of unintentional weight loss as you get older. Unintentional weight loss is sometimes associated with severe muscle loss, and weakened muscles can increase your risk for falls and fractures.25
Additional ways to protect yourself against fractures include:
Weight-bearing exercises: Walking and resistance training can help to protect you against bone loss and bone density problems (osteopenia and osteoporosis).26 Weight-bearing exercises can also reduce your risk for fractures because they improve your balance, posture, and responsiveness.
Wise lifestyle choices: Both cigarette smoking and excessive alcohol consumption can increase your risk for osteoporosis.27 Alcohol can also affect your balance and reaction time, which can increase your risk of falling and getting a broken bone.
Ask about medications: Some medications can make people feel dizzy or unsteady, which can lead to a fall. If you notice these types of side effects with any of your treatments, you should let a healthcare provider know right away. They can reassess your treatment plan and prescribe medications without these side effects.
Prioritize treatment: If you have been diagnosed with osteoporosis or another serious health condition, stay on top of treatments and take medications exactly as prescribed. You should follow up with your healthcare provider a few times a year to reassess treatments and see if they are helping.
Wear supportive shoes: Shoes should offer good support, be nonslip, and be in good shape to prevent falls. Pay attention to your movements, especially when going up and down stairs or carrying heavy items. If you can, stay home when the weather is icy and slippery. If you cannot stay home, consider using safety gear (such as putting traction grips on your footwear and using walking poles) and be mindful of your movements.
Wear protective gear: If you are enjoying a leisure activity or sport, such as cycling, skating, skiing, or contact sports, wear the suggested protective gear.28 Gear can include a helmet, pads, and guards.
Treatment and Management With a Fracture and Obesity
A fracture means your bone is broken, and you need medical care.29 In some cases, a broken bone may require surgery to repair it. In other cases, it can be splinted or placed in a cast until the bone heals.
Should you experience a fracture, seek out medical treatment right away. If your injury is the result of trauma, call 911 or have someone take you to an emergency room. An orthopedist (a medical specialist who diagnoses and treats injuries and diseases of the musculoskeletal system) can address a less severe break.
When you seek treatment, the healthcare provider will examine the broken bone and request imaging tests. Depending on the cause, you may be in the emergency room or a medical provider's office. Imaging tests used to diagnose fractures include:
How your fracture will be treated depends on which bone and which area of the bone is affected, and what caused the break.
Treatment methods for a fracture include nonsurgical and surgical options.30
Nonsurgical treatments for a fracture include:
Casting: This method uses a plaster or fiberglass cast to immobilize the bone while healing.
Bracing: A brace offers support around the injured part of the body to protect the broken bone.
Traction: This involves using pulleys or ropes to pull a bone or injured body part back into the correct position to restore alignment and keep it in place.
Surgical treatments include:
An open reduction and internal fixation procedure: The open reducing procedure is done to restore the fractured bone to its normal position. The internal fixation uses special screws and plates to attach the outer surface of the affected bone.
Most people who experience a fracture can fully recover and resume regular activity after the bone heals. However, some fractures can have a longer recovery time and may lead to long-term effects. A rehabilitation plan as your bone heals can lead to a successful recovery.
Aspects of a successful recovery plan include
If you have had a significant fracture that required surgical treatment (i.e., knee or hip surgery), you may be sent to a rehabilitation center for short-term care. At the rehabilitation center, you can access physical and occupational therapists who can assist with exercises and work with you until you can go home.
If you end up going home after surgery, you may need additional support. In-home physical therapy or a caregiver can assist you with household chores and activities of daily living until you are strong enough to attend physical therapy at a medical facility and care for yourself at home.
Summary
Being overweight or having obesity can increase your risk for bone health problems, including fractures and arthritis. Being underweight can also increase the risk of fractures.
Treatments for a fracture depend on the affected bone area and the severity of the break. They may include nonsurgical options (casting and bracing) and surgical options to repair and align a broken bone to facilitate healing. If you have had surgery, you will need a rehabilitation plan, which includes physical therapy at home or a rehab facility.
Maintaining good lifestyle habits, including healthy eating, exercising, and losing excess weight, can help you keep your bones and joints healthy and reduce your risk for fractures. If you need help losing weight, reach out to a healthcare provider. They can help you create a weight-loss plan that works best for your unique health situation.