The Phenomenon of “Obesity Paradox” in Neck of Femur Fractures

  • Muhammad Tahir Jinnah Postgraduate Medical Centre
  • Nadeem Ahmed, Dr Jinnah Postgraduate Medical Centre
  • Muhammad Qasim Ali Samejo, Dr Jinnah Postgraduate Medical Centre
  • Allah Rakhio Jamali, Prof Jinnah Postgraduate Medical Centre
Keywords: Hip fractures, Mortality, Obesity paradox


Objective: To determine the association of body mass index (BMI) with 30 days and 1-year mortality outcomes of orthopedic elderly patients after hip fracture surgery.

Methods: This is prospective study conducted at Department of Orthopaedics, at a tertiary care public sector hospital in Karachi between Jan-2016 to Jan-2018. In this short follow-up study, we included the data of 490 patients, who were operated for neck of femur fractures in a public sector tertiary care hospital between Jan-2016 to Jan-2018. Patients were divided into different categories on the basis of BMI; BMI <20 Kg.m-2 underweight, 20-24.99 Kg.m-2 normal weight, BMI 25-29.99 Kg.m-2 overweight, ≥30 obese. Mortality at 30 days and 1-year mortality were primary study end-points.

Results: Rate of re-admission within 30 days, major adverse cardiovascular events (MACE) within 30 days and 30 days mortality was high in underweight and lowest in obese patients. Thirty-day mortality rate was 2.7% in underweight, 1.3% in normal weight, 0.64% in over-weight and 0.0% in obese patients but this was not significant statistically (p-value 0.29). One-year mortality rate was significantly high in under-weight patients, 34.2%, 25.9% in normal weight, 21.4% in overweight and only 14.5% in obese patients (p-value 0.009). Age ≥ 65 years (odds ratio 0.40 (0.26-0.63), and ASA III-IV (odds ratio; 0.27 (0.16-0.45) are also significant risk factors of 1-year mortality

Conclusion: BMI classification can serve as an important indicator of adverse early outcomes after hip fracture surgery. Over-weight and obese patients have better survival outcomes and have lower 1-year mortality rate.


How to cite this:
Tahir M, Ahmed N, Samejo MQA, Jamali AR. The Phenomenon of “Obesity Paradox” in Neck of Femur Fractures. Pak J Med Sci. 2020;36(5):1079-1083. doi:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Biographies

Nadeem Ahmed, Dr, Jinnah Postgraduate Medical Centre

Associate Professor

Jinnah Postgraduate Medical Centre

Muhammad Qasim Ali Samejo, Dr, Jinnah Postgraduate Medical Centre

Department of Orthopaedics

Assistant Professor (Current Charge)

Allah Rakhio Jamali, Prof, Jinnah Postgraduate Medical Centre

Head of Department

Department of Orthopaedics

How to Cite
Tahir, M., Ahmed, N., Ali Samejo, M. Q., & Jamali, A. R. (2020). The Phenomenon of “Obesity Paradox” in Neck of Femur Fractures. Pakistan Journal of Medical Sciences, 36(5).