“…8 However, in a model of accelerated aging that combined a WRN mutation with the shortened telomeres of telomerase (TERC) knockout mice, the simultaneous loss of WRN and TERC genes produced a low bone mass phenotype, and age-related osteoporosis resulted from impaired osteoblast differentiation. 9 Although there is no evidence to date for the expression and function of the WRN protein in human bone cells including osteoblasts, this, along with a subsequent report, 10 suggests that defective osteoblast differentiation as a result of telomere dysfunction is an important cellular mechanism that could partly explain the early onset of osteoporosis in patients with WS. It is unclear why femoral bone is more susceptible to osteoporosis than lumbar vertebral bone is, in this patient population, but it might be the case that mechanical offloading of the femur as a result of muscle atrophy and intractable leg ulcers could contribute to skeletal atrophy of the lower extremities in patients with WS.…”