The obesity paradox and osteoporosis

Abstract

Overweight and obesity according to the definition of the WHO are considered as an abnormal or excessive fat accumulation that may impair health. Studies comparing fracture incidence in obese and non-obese individuals have demonstrated that obesity, defined on the basis of body mass index (BMI), is associated with increased risk of fracture at some sites but seems to be protective at others. The results of the studies are influenced by the distribution of BMI in the population studied; for example, in cohorts with a low prevalence of obesity, a predilection for certain fracture sites in obese individuals becomes difficult to detect, whereas, in populations with a high prevalence of obesity, previously unreported associations may emerge. Furthermore, obesity can bring with itself many complications (Type 2 diabetes mellitus, vitamin D deficiency, and motor disability) which, in the long run, can have a definite influence in terms of overall risk and quality of life, as well. This is a narrative review focusing on the relationship between bone metabolism and overweight/obesity and dealing with the fundamental dilemma of a disease (obesity) apparently associated with improved values of bone mineral density, part of a complicated relationship which revolves around obesity called "the obesity paradox".

Associations of Weight-Adjusted Body Fat and Fat Distribution with Bone Mineral Density in Chinese Children Aged 6–10 Years

“…Traditionally, obesity is considered osteoprotective because of the weight-bearing effect of excess adipose tissue on the skeleton and the stimulation of osteoblast differentiation by increased mechanical stress on the bone [1][2][3]. Recently, however, this widely held belief has been challenged [4][5][6]. Fat mass (FM) tissue is metabolically active, and therefore its influence on the skeleton may also involve other non-weight-bearing effects [7,8].…”

Vaspin antagonizes high fat-induced bone loss in rats and promotes osteoblastic differentiation in primary rat osteoblasts through Smad-Runx2 signaling pathway

“…Osteoporosis and obesity are interrelated metabolic derangements, which are serious and prevalent health issues [1]. Osteoporosis and related bone fractures are growing medical problems affecting more than 200 millions of people worldwide and appear to be associated with high disability and mortality, especially in older men and postmenopausal women [2].…”

H. pylori is related to osteoporosis but only in premenopausal female: a cross-sectional study

“…However, the effect of obesity remains unclear. On the one hand, obesity has traditionally been considered positive for bone because of the bene cial effect of mechanical loading 31 . On the other hand, people hold the view that BMI may harm BMD.…”