LAUSR

The relationship between BMI and risk of fracture varies between skeletal sites. In a meta-analysis, higher BMI was protective against hip fracture and osteoporotic fractures in general but not against fractures in the upper arm and lower leg (2). In addition, fat distribution matters; it previously was reported that abdominal obesity was associated with increased risk for hip fracture after adjustment for BMI (3), and for the first time, Paik et al. (1) report the same for vertebral fractures. Vertebral fractures are challenging to study, as these fractures are often not recognized and diagnosed. In this study, Paik et al. were able to prospectively assess the association between BMI, waist circumference, and confirmed vertebral fracture (medical records/x-ray descriptions) in ~ 55,000 women participating in the 19th and/or 20th questionnaire cycle of the decades-long Nurses’ Health Study (1).