Every extra 2 inches on waist raises risk of fractures by 7%, study

Middle-age spread linked to brittle bones: Every 2inches of fat around a woman’s waist raises risk of a fracture by 7%, study finds

  • Major Canadian study tracked 20,000 people of various weights over six years 
  • Women with big waistlines were found to have a greater risk of breaking bones
  • Experts say being more top heavy puts bones like those found in ankles at risk

The dreaded middle-age spread raises the risk of women fracturing their bones, a study suggests.

Experts from Canada followed 20,000 men and women aged 40 to 70 for six years.

They found every extra two inches (5cm) on a woman’s waist increased their risk of breaking a bone by up to 7 per cent.

Researchers said the finding has ‘major implications for public health’ and goes against the idea fat people have stronger bones due to extra body weight increasing bone density. 

The study found for every extra two inches (5cm) on a woman’s waist was linked to a 7 per cent higher risk of suffering a below-knee fracture and 3 per cent higher risk of a break of any kind. 

Experts say they suspect fatter women were less able to rebalance from a potential fall due to the extra weight on their waists. 

This put their ankles, which aren’t cushioned by any soft tissues, at risk of breaking if they fell.

The NHS says women should try to keep their waistline below 31.5in (80cm). 

But as 70 per cent of women in England have a waistline above that, it suggests the majority are at a greater risk of fractures.

Canadian experts say every two inches on a woman’s waistline increased her chance of breaking a bone in her lower leg by 7 per cent (stock image)

The study, carried out by researchers from Laval University in Quebec, involved 9,985 women and 9,372 men. 

Participants were recruited between 2009-2010 and followed for about six years, in which time over 800 suffered a fracture.

The location of these breaks, and the patient’s waist circumference and BMI, were then analysed to measure the difference in fracture risk.

While waistline was described as the biggest factor in a women’s risk of a fracture, they found women with a higher BMI were also at greater risk.

Women with a BMI of more than 40 — considered obese — were 40 per cent more likely to suffer a fracture below their knee than those with a BMI of 25, considered healthy. 

In England, 29 per cent of women fall into the fattest category. 

Women with a BMI of 27.5, who are considered overweight, had a 5 per cent increased risk of a lower limb fracture compared to women with a healthy BMI.

How to calculate your waistline and what it means

 Measuring your waist is a good way to check you’re not carrying too much fat around your stomach, which can raise your risk of heart disease, type 2 diabetes and stroke.

You can have a healthy BMI and still have excess tummy fat, meaning you’re still at risk of developing these conditions.

To measure your waist: 

Regardless of your height or BMI, you should try to lose weight if your waist is:

  • 94cm (37ins) or more for men
  • 80cm (31.5ins) or more for women

You’re at very high risk and should contact a GP if your waist is:

  • 102cm (40ins) or more for men
  • 88cm (34ins) or more for women


But experts spotted the opposite trend in men.  

Being underweight, having a BMI less than 18.5, was associated with a higher risk of arm fractures.

The experts said further research is needed to establish if this trend is true in a larger sample size.

But it could be due to underweight men having less tissue on their arms which could protect their bones from a break.  

Lead author of the study, Dr Anne-Frederique Turcotte an expert in hormones and body function, said the data suggested waist circumference was a better measure of fracture risk in obese people.

‘This may be due to visceral fat – fat that is very metabolically active and stored deep within the abdomen, wrapped around the organs – secreting compounds that adversely affect bone strength,’ she said.

She also theorised the way people with larger waists carried their weight might also be behind the observed trend. 

‘We also know that people with obesity take longer to stabilise their body, when they trip, for example,’ she said. 

‘This is particularly pronounced when weight is concentrated at the front of the body, suggesting that individuals with distribution of body fat in the abdominal area may be at higher risk of falling.’

Dr Turcotte said the discovery had major public health implications considering how long fatter patients take to recover from broken bones.

‘We know that individuals with obesity who sustain a fracture are more likely to have other health problems that may cause slower rehabilitation, increase the risk of post-operative complications and malunion (fractures that may not heal properly), generating substantial healthcare costs,’ she said.

‘The ageing of the population and the rising incidence of obesity may lead to rising rates of fractures in coming years.’    

She said another finding of the study, that underweight were twice as likely to have an arm fracture, needed further investigations.

NHS advice warns that carrying too much fat on your waist can increase your risk of heart disease, type 2 diabetes and a stroke.

This is because the fat that accumulates around our waistlines is around several vital organs and usually indicates there is fat within the organs themselves, even among people with a healthy BMI.

The Canadian analysis, which has not been peer-reviewed was presented at the European Congress on Obesity in Maastricht in The Netherlands.


Meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain, according to the NHS

• Eat at least 5 portions of a variety of fruit and vegetables every day. All fresh, frozen, dried and canned fruit and vegetables count

• Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain

• 30 grams of fibre a day: This is the same as eating all of the following: 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and large baked potato with the skin on

• Have some dairy or dairy alternatives (such as soya drinks) choosing lower fat and lower sugar options

• Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily)

• Choose unsaturated oils and spreads and consuming in small amounts

• Drink 6-8 cups/glasses of water a day

• Adults should have less than 6g of salt and 20g of saturated fat for women or 30g for men a day

Source: NHS Eatwell Guide 

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