ABSTRACT
This chapter describes the interaction of obesity with disorders of bone fragility and osteoarthritis. Obesity is linked to these conditions through its effects on biomechanics and systemic inflammation. Obesity has a complex interaction with fracture risk. Though high body mass index (BMI) appears to be associated with a minor decrease in the risk of fracture, obesity-associated frailty and increased visceral adiposity increase the risk of fracture. Clinical management includes screening appropriate populations and intervention with lifestyle changes, vitamin D and mineral supplementation, and osteoporosis pharmacotherapy. The effects of voluntary weight loss on fracture risk are not definitively known. Osteoarthritis (OA) is increased in obesity in both weight-bearing and non-weight-bearing joints. Weight loss appears to be an effective intervention for reducing pain with knee and hip OA in patients with obesity and requires either a potent weight reduction intervention such as bariatric surgery, or the combination of diet and exercise, with an achieved weight loss of at least 6%. Obesity in patients undergoing total joint arthroplasty (TJA) is associated with greater short- and long-term surgical complications, and weight-loss interventions should be considered in select patients prior to TJA.
