BMI and BMD: The Potential Interplay between Obesity and Bone Fragility

Abstract

Recent evidence demonstrating an increased fracture risk among obese individuals suggests that adipose tissue may negatively impact bone health, challenging the traditional paradigm of fat mass playing a protective role towards bone health. White adipose tissue, far from being a mere energy depot, is a dynamic tissue actively implicated in metabolic reactions, and in fact secretes several hormones called adipokines and inflammatory factors that may in turn promote bone resorption. More specifically, Visceral Adipose Tissue (VAT) may potentially prove detrimental. It is widely acknowledged that obesity is positively associated to many chronic disorders such as metabolic syndrome, dyslipidemia and type 2 diabetes, conditions that could themselves affect bone health. Although aging is largely known to decrease bone strength, little is yet known on the mechanisms via which obesity and its comorbidities may contribute to such damage. Given the exponentially growing obesity rate in recent years and the increased life expectancy of western countries it appears of utmost importance to timely focus on this topic.

Bioavailable 25(OH)D but Not Total 25(OH)D Is an Independent Determinant for Bone Mineral Density in Chinese Postmenopausal Women

“…Although the results were sometimes controversial, many epidemiological studies have reported that postmenopausal women with higher BMI had a reduced risk for hip or pelvis fracture (DiPietro et al, 1993, Gnudi et al, 2009, Prieto-Alhambra et al, 2012, Sogaard et al, 2015). However, it was estimated that, for obese populations, there is a U-shape relationship between BMI and fracture risk and that the protective effects of weight on bone are reduced along with the increment of BMI (Palermo et al, 2016). The PTH was elevated in the obese women, which might damage the bone architecture and reduce the BMD values (Goldner et al, 2008, Bolland et al, 2006).…”

“…The PTH was elevated in the obese women, which might damage the bone architecture and reduce the BMD values (Goldner et al, 2008, Bolland et al, 2006). The inflammation factors and adipokines secreted from the white adipose tissue could stimulate bone resorption, and abdominal/visceral obesity is usually associated with lower BMD values (Palermo et al, 2016). Moreover, a higher BMI is associated with the reduced bioavailability of 25(OH)D (Wortsman et al, 2000, Vimaleswaran et al, 2013).…”

Mechanical signals protect stem cell lineage selection, preserving the bone and muscle phenotypes in obesity

“…In addition to storing energy, it is also an active endocrine organ that modulates adipokine (e.g., leptin, resistin, adiponectin) and inflammatory cytokine (e.g., TNFα, IL-6, TGF-β) release, 21 affecting both local and systemic environments. Fat tissue plays a role in a range of physiological processes, including immune function, 22 glucose homeostasis, 23 and energy balance.…”

Gordura visceral medida por DXA está associada com risco aumentado de fraturas não vertebrais em mulheres idosas não obesas: São Paulo Ageing e Health (SPAH) Study

“…A obesidade pode ser definida como uma desordem metabólica complexa envolvendo um acúmulo anormal ou excessivo de gordura corporal (Palermo et al, 2016). Dados da Organização Mundial de Saúde (OMS) mostram que em 2014 mais de 1,9 bilhões de adultos podiam ser classificados como sobrepeso e, desses, mais de 600 milhões eram obesos, correspondendo a 13% da população adulta mundial (Palermo et al, 2016;WHO, 2016 (Pisani et al, 2016).…”

“…Dados da Organização Mundial de Saúde (OMS) mostram que em 2014 mais de 1,9 bilhões de adultos podiam ser classificados como sobrepeso e, desses, mais de 600 milhões eram obesos, correspondendo a 13% da população adulta mundial (Palermo et al, 2016;WHO, 2016 (Pisani et al, 2016).…”