Table 2 Studies on the association of obesity/overweight with musculoskeletal health.

[25]

Study

40–69

709

Japanese women.

22.6 ± 2.7

Measured BMI,

current smoking

habits, frequency

of pain, and difficulty

of daily

movements.

Age and current smoking.

Questionnaires.

Higher prevalence of frequent shoulder pain at age 50, and increased prevalence of frequent leg pain and difficulty with daily movements as a result of increased BMI.

[26]

Cross-sectional

25–65; 38.2 ± 10.5 (W)

802 (T),

374 (W)

27.8 ± 5.6 (W)

3 BMI groups:

<25 (acceptable

weight), 25–29.9

(people with overweight), and BMI > 30 (people with obesity), age, educational

level, occupation,

place of living,

type of housing

condition, and

smoking habits.

None.

Face-to-face interview questionnaires.

LBP prevalence in individuals with obesity is higher among females (41.3%) than males (24.6%). Moderate association between BMI and obesity.

[68]

Cross-sectional

(Finland)

24–39

2182 (T),

1172 (W)

24.5 ± 4.6

(W)

3 BMI classes:

25.0–29.9 kg/m²

(people with overweight),

30.0–34.9

kg/m² (people with obesity),

>35.0 kg/m²

(people with severe obesity), weight circumference,

hip

circumference,

weight-to-hip

ratio, socioeconomic

factors,

C-reactive protein,

leptin,

Adiponectin,

smoking, and leisure time

physical

activity.

Age, socio-economic

status, and smoking.

Questionnaires.

Women with higher

BMI, waist and hip circumference, waist-to-hip ratio, serum leptin levels, and C-reactive protein showed a higher prevalence of obesity.

[29]

Cross-sectional

38.3 ± 8.9 (people with obesity w/o

LBP), 42.8 ± 11.9 (people with obesity with

LBP),

31.9 ± 8.6

(people with normal

weight)

37 (W)

(13 people with obesity

w/o LBT,

13 with

LBP, 11

normal)

BMI

39.2 ± 3.6

kg/m²

(people with obesity

w/o

LBP),

41.9 ± 5.3

kg/m²

(people with obesity

with

LBP),

20.1 ± 1.2

kg/m²

(people with normal weight)

3 BMI groups:

People with obesity without

LBP, people with obesity with

non-specific LBP,

healthy subject, kinematic data

of lateral bending

and forward

flexion.

N/A

6-camera optoelectronic

motion

analysis system.

Participants with obesity exhibited a reduced range of motion in the spine as a result of reduced mobility at pelvic and thoracic levels. Patients with obesity and cLBP showed increased lumbar lordosis.

A higher degree of spine impairment was observed in subjects with cLBP compared to subjects with obesity but no cLBP.

[30]

Prospective

cohort

study (Norwegian

county)

30–69 at

baseline

25,450

(T),

14048

(W)

<25 to

≥30

BMI groups:

<25, 25–29.9,

≥30 (measured

at clinical

examination), presence/absence

of cLBP, personal

features (gender,

age, education,

work status,

physical activity,

smoking habit),

medical examination

(blood

pressure and lipid

levels), and follow up

after 11 years.

Age, education,

work status, physical

activity, smoking,

blood pressure, and

lipid levels.

Survey questionnaires and clinical

consultation.

Women reported higher crude risk, and a higher crude recurrence of LBP than men across all age groups. Higher BMI values were associated with increased recurrence of LBP in both men and women. Recurrence of LBP was associated with increasing BMI among women after adjusting for age, but the association was weakened by further adjustment for confounding factors.

[34]

Meta-analysis of prospective cohort study

Adults

3,126,313

(T)

≥28.0

kg/m²

BMI (normal weight group, group with obesity) and hip fracture.

Varied adjustment

parameters across

the selected studies,

which included

age, height, physical

activity, diabetes

mellitus, smoking,

etc.

Data extracted from published cohort studies through systematic review of articles.

Studies suggest that obesity significantly reduces the risk of hip fractures.

[36]

Cohort

study

(Norway)

50–79 at

baseline;

mean age

65.3

61,787

(T),

29,511

(W)

<22 to ≥30

4 BMI groups:

(<22, 22– < 25,

25– < 30, and ≥30) (BMI measured Objectively);

Hip fraction definition according to International Classification of Diseases, Ninth Revision (codes 820-820.9), and the International Classification of Diseases, Tenth Revision (codes S72.0-S72.2).

Age, marital status,

height, smoking,

degree of urbanization,

and survey

region.

Surveys and hip

fracture data

obtained electronically

from hospitals.

Women with higher BMI (≥25) had a decreased risk of hip fracture compared with those

with BMI <22 and 22–24.9. Inverse association between BMI and hip-fracture was linear among women aged 70–79. However, for the age group of 50–59 and 60–69,

the hip fracture risk was highest for those with BMI < 22, and the curved association levelled off at BMIs of 25 and above.

[35]

Cross-sectional and longitudinal

50 and above

56,002

(T),

51,313

(W)

<18.5 to

≥35

BMI groups:

<18.5 kg/m²

(people with underweight),

18.5 to <25 kg/m²

(people with normal weight),

25 to <30 kg/m²

(people with overweight), ≥30 to <35 kg/m²

(people with class I obesity), ≥35

kg/m² (people with class II obesity) using WHO

standard, cross-sectional

moment

of inertia, cross-sectional

area,

femoral strength

index, incident

major

osteoporotic

fractures.

Age, prior fracture,

parental hip fracture,

rheumatoid arthritis,

chronic obstructive

pulmonary disease,

alcohol abuse

diagnosis, recent glucocorticoid

use, and

recent osteoporosis

medication use.

Dual-energy

X-ray absorptiometry

(Lunar

DPX prior to

2000; GE Lunar

Prodigy after

2000) for bone

mineral density,

height and

weight measured

by stadiometer

and floor scale

in 82%, as well

as by self-report

in 18%, hospital

records.

Association of

increased BMI with

a lower risk of major

osteoporotic fractures

and hip fracture in

women. The protective

association of BMI

with MOF was largely

explained by the

higher bone mineral

density, but partially

for the association of

BMI with hip fracture.

This suggests that

factors not associated

with BMD, such as

soft tissue thickness at

the hip may have contributed

to the lower

risk of hip fracture

among women.

[31]

New analysis

of a

previous

cross-sectional

study

40–59

6079 (W)

24.4

BMI groups;

<18.5 kg/m²

(low body

weight), 18.5 to

24.9 kg/m² (normal

weight), BMI

25.0 to 29.9 kg/m² (overweight),

≥30.0 kg/m²

(obesity), abdominal

perimeter,

age, personal

study level,

smoking, alcohol

consumption,

physical activity,

parity, having a

stable partner,

natural or surgical

menopause,

anxiety and

depressive symptoms,

use of

hormonal or

alternative

therapies for

menopausal

symptoms, oral

contraceptive use, and past history of chronic

diseases.

N/A

Questionnaires.

Women with low BMI had a decreased risk of musculoskeletal pain, overweight women had a higher

risk, and women with obesity had the highest risk compared to those of normal weight. Obesity is a significant risk factor for musculoskeletal

pain in middle-aged women.

[37]

Cohort

study

(Korea)

59.9 ± 7.4

years

288,058

(T), 6079

(W)

24.1 ± 3.0

7 BMI groups:

<18.5, 18.5–20.9,

21–22.9,

23–24.9, 25–27.4,

27.5–29.9, ≥30,

age, sex, smoking

habit, alcohol

use, physical

activity, income

status, comorbidity, and

medication

use.

Age, sex, smoking

status, alcohol consumption,

physical

activity, beneficiary

income status,

oral steroid use,

hormone replacement

therapy use,

and prevalent osteoporosis,

comorbid

diabetes, hypertension,

rheumatoid

arthritis, ischemic

stroke, myocardial

infarction, heart failure,

liver cirrhosis,

and chronic kidney

disease.

Objectively measured

BMI,

fasting serum

glucose assessed

using enzymatic

methods,

Smoking history,

alcohol use, and

physical activity

reported via a

questionnaire.

Overweight group exhibited the lowest risk of hip fracture. An inverse association between BMI and hip fracture was observed in women with a BMI

<25 kg/m². Among women with BMI ≥ 25, a 5% increase in BMI was associated with a 26% increase in hip fracture risk.

[54]

Experimental

study

19–48;

mean

33.11

132 (T),

50 (W)

Mean

BMI

26.31 ± 2.75

Anthropometric

measures of obesity

(weight,

body mass index,

waist circumference,

hip

circumference,

and waist-hip

ratio) and degree

of pain intensity.

N/A

Height and

weight measured

by stadiometer

and waist and hip

circumferences

measured using

flexible tapes.

Intensity of pain

was rated using

visual analog

scales.

No association was found

between the anthropometric

indices of obesity and the degree of pain intensity in patients with chronic non-specific low back pain.

[53]

Observational

analytic

study

with cross

sectional

50–60

(54.08 ± 4.00)

12 (W)

BMI

31.52 ± 3.83

(26.4 to

36.9)

BMI, age, height,

weight, Lumbosacral

axis, and

pain intensity on

Visual Analog

Scale.

N/A

Lumbosacral photography,

visual

analog scale for

pain intensity

reading.

No significant association was found between BMI and low back pain. A significant association was observed between BMI and the lumbosacral axis.

[69]

Cross-sectional

study

≥70

14,155

(T), 7680

(W)

27.9 ± 4.5

(T)

Pain data,

BMI, age,

living arrangement,

years

of education

and depressive

symptoms.

Age and depression.

Self-reported

paint data,

objectively measured

height

and weight,

questionnaires, and

depressive symptoms

assessed

via the Center

for Epidemiologic

Studies

Depression Scale.

Overweight female participants had 50% higher odds of reporting moderate to severe

LBP compared to healthy counterparts at baseline, after

adjusting for age and depression. Male and female subjects with obesity had more than twice the odds of reporting moderate to severe LBP compared to healthy individuals at baseline BMI.

[32]

Cross-sectional

study

Age >18;

46.28 ± 10.59

(W)

466 (T),

342 (W)

Participants

mean

BMI

42.77 ± 5.64;

42.52 ± 10.51

(W)

BMI ≥ 35 kg/m²

with comorbidities

or ≥40

kg/m² without

comorbidities,

personal feature

(gender,

age and body

mass index), and

pain intensity in

seven anatomical

region.

N/A

Pain intensity

assessed using

a numeric rating

scale ranging

from 0 to 10.

A higher prevalence

of MSK pain was observed in women compared to

men (95% vs. 77.4%).

Pain intensity was also

higher among females.

A moderate positive

correlation between

BMI and numeric

rating scale scores was found in women for the shoulder

(p = 0.010), knee (p = 0.042), and ankle

(p = 0.024). No Significant associations were found for other regions in either men or women.

[55]

Prospective

population based

cohort

(UK)

45–64

938 (W)

25.51 ± 4.15

(at

baseline,

year 1),

27.80 ± 4.90

(end of

follow up,

year

20)

BMI groups:

People with slight overweight, lower overweight to obesity, upper overweight to obesity, lower obesity,

upper obesity, and two groups of people with normal weight;

musculoskeletal

pain, age, current

menopause

status, physical

activity, use

of oral contraceptive

pill or

hormone replacement

therapy, use

of analgesic medication

, history

of hysterectomy,

cancer, orthopedic

operations,

other major illness,

and any

fractures in last

10 years.

Age, menopause status,

the number of

live births, smoking

habits, alcohol

drinking, physical

activity, oral contraceptive

pill use,

hormone replacement

therapy use,

analgesic use, hysterectomy,

cancer,

fractures, orthopedic

operations, and

other major illness.

Medical examinations.

Women with BMI

27–34 were more

likely to experience

musculoskeletal

pain and those with

BMI above 40 had a

higher risk of all-cause

and cardiovascular

mortality.

[58]

Cross-sectional

study

18–32 and

45–88

141 postmenopausal

and 118

young

women

27.1 ± 5.3

postmenopausal and

22.4 ± 4.5

Body composition,

bone

density, handgrip

strength, and physical

performance.

None.

Bio-electrical

impedance analyzer,

calcaneal

quantitative

ultrasound, hand

dynamometer,

and modified

short physical

performance

battery test.

Higher prevalence of low muscle mass was observed among young participants compared to older adults. Older adults had a higher prevalence of obesity and low bone density compared to younger counterparts.

[56]

Cross-sectional

study

25–65

443 (W)

≤18.5

kg/m²

to ≥30

kg/m²

BMI, height,

weight, and musculoskeletal

pain.

None.

Objectively measured

height and

weight, questionnaire.

Increased risk of upper and lower back pain was observed among women with obesity and overweight.

[57]

Analytical

cross-sectional

study

53.0

median

19,716

(T),

10,282

(W)

≤18.5

kg/m²

to ≥30 kg/m²

Age, sex, BMI,

chronic low back

pain, and physical

activity.

Sex, age, physical

occupational

demands, and recreational

physical

activity.

Self-reported

BMI and

Questionnaire.

Obesity increased the odds of chronic low back pain (cLBP) by 1.719 times, and being female increased the odds by 1.683 times.