Abdominal and hip fat percentages are associated with fragility fractures: evidence from a large cross-sectional study.

The distribution of body fat may influence fracture risk, yet the association between DXA-derived regional fat and fragility fractures remains unclear. We analysed 36,235 patients undergoing lumbar spine and femoral DXA scans from June 2004 to February 2024, categorizing abdominal, left hip, and right hip fat percentages into tertiles (low, medium and high). Multivariable logistic regression models were fit with the dependant variable being hip or any fragility fracture and the independent variable being the binary regional body composition groups. All results were adjusted for FRAX clinical factors where we found that the lowest tertile of abdominal fat was associated with reduced odds of any fracture (OR 0.78, 95% CI 0.74-0.82), while the highest tertile was linked to increased odds (OR 1.22, 95% CI 1.17-1.29) but was not associated with hip fracture. For left hip fat, the lowest tertile was linked to decreased odds of any fracture (OR 0.61, 95% CI 0.58-0.64), and the highest tertile showed increased odds of any fracture (OR 1.57, 95% CI 1.50-1.65) and hip fracture (OR 1.32, 95% CI 1.07-1.63). Similarly, the right hip fat lowest tertile was associated with reduced odds of hip fracture (OR 0.74, 95% CI 0.58-0.93) and any fracture (OR 0.62, 95% CI 0.59-0.66), while the highest tertile was linked to increased odds of hip fracture (OR 1.68, 95% CI 1.37-2.07) and any fracture (OR 1.59, 95% CI 1.52-1.67). Our results suggest DXA derived regional body composition may be a novel predictor of both hip and any fragility fractures with further research needed to validate our findings.