Women with severe obesity and relatively low bone mineral density have increased fracture risk

Cawsey, Sarah; Padwal, Raj; Sharma, Arya M.; Wang, X.; Li, S.; Siminoski, Kerry

doi:10.1007/s00198-014-2833-z

Cited by 29 publications

(17 citation statements)

References 53 publications

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“…Sarcopenic and dynopenic obese individuals appear to be at a greater risk for lower BMD and higher fracture risk than obese individuals with normal muscle mass and strength (Scott, et al 2016). This interpretation is consistent with studies reporting that obese osteopenic individuals are at a higher fracture risk compared to normal weight osteopenic individuals (Cawsey, et al 2015). Finally, sarcopenia and dynopenia could result in higher strain levels during a fall or increased fall frequency.…”

Section: Scaling Bone Mass To Body Weightsupporting

confidence: 92%

Influence of body weight on bone mass, architecture and turnover

Iwaniec

Turner

2016

Journal of Endocrinology

137

108

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Weight-dependent loading of the skeleton plays an important role in establishing and maintaining bone mass and strength. This review focuses on mechanical signaling induced by body weight as an essential mechanism for maintaining bone health. In addition, the skeletal effects of deviation from normal weight are discussed. The magnitude of mechanical strain experienced by bone during normal activities is remarkably similar among vertebrates, regardless of size, supporting the existence of a conserved regulatory mechanism, or mechanostat, that senses mechanical strain. The mechanostat functions as an adaptive mechanism to optimize bone mass and architecture based on prevailing mechanical strain. Changes in weight, due to altered mass, weightlessness (spaceflight), and hypergravity (modeled by centrifugation), induce an adaptive skeletal response. However, the precise mechanisms governing the skeletal response are incompletely understood. Furthermore, establishing whether the adaptive response maintains the mechanical competence of the skeleton has proven difficult, necessitating development of surrogate measures of bone quality. The mechanostat is influenced by regulatory inputs to facilitate non-mechanical functions of the skeleton, such as mineral homeostasis, as well as hormones and energy/nutrient availability that support bone metabolism. While the skeleton is very capable of adapting to changes in weight, the mechanostat has limits. At the limits, extreme deviations from normal weight and body composition are associated with impaired optimization of bone strength to prevailing body size.

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Section: Scaling Bone Mass To Body Weightsupporting

confidence: 92%

Influence of body weight on bone mass, architecture and turnover

Iwaniec

Turner

2016

Journal of Endocrinology

137

108

View full text Add to dashboard Cite

show abstract

“…44 However, other studies point to an inverse relationship with BMD. 45, 46 These conflicting observations highlight the complexity of the relationship, an observation that is also seen in the mouse literature. For example Li et al , 47 studying multiple inbred mouse strains, concluded that the relationship between BMD and body composition, particularly fat mass, is dependent on the diet used.…”

Section: Discussionmentioning

confidence: 94%

The role of sex and body weight on the metabolic effects of high-fat diet in C57BL/6N mice

2017

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Background:Metabolic disorders are commonly investigated using knockout and transgenic mouse models on the C57BL/6N genetic background due to its genetic susceptibility to the deleterious metabolic effects of high-fat diet (HFD). There is growing awareness of the need to consider sex in disease progression, but limited attention has been paid to sexual dimorphism in mouse models and its impact in metabolic phenotypes. We assessed the effect of HFD and the impact of sex on metabolic variables in this strain.Methods:We generated a reference data set encompassing glucose tolerance, body composition and plasma chemistry data from 586 C57BL/6N mice fed a standard chow and 733 fed a HFD collected as part of a high-throughput phenotyping pipeline. Linear mixed model regression analysis was used in a dual analysis to assess the effect of HFD as an absolute change in phenotype, but also as a relative change accounting for the potential confounding effect of body weight.Results:HFD had a significant impact on all variables tested with an average absolute effect size of 29%. For the majority of variables (78%), the treatment effect was modified by sex and this was dominated by male-specific or a male stronger effect. On average, there was a 13.2% difference in the effect size between the male and female mice for sexually dimorphic variables. HFD led to a significant body weight phenotype (24% increase), which acts as a confounding effect on the other analysed variables. For 79% of the variables, body weight was found to be a significant source of variation, but even after accounting for this confounding effect, similar HFD-induced phenotypic changes were found to when not accounting for weight.Conclusion:HFD and sex are powerful modifiers of metabolic parameters in C57BL/6N mice. We also demonstrate the value of considering body size as a covariate to obtain a richer understanding of metabolic phenotypes.

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“…When evaluating the influence of increasing body fat in elderly patients with obesity, it was found that greater adiposity and adipokine levels were associated with reduced lean mass, lower BMD, and increased fracture risk. 31 A clinical study assessing 400 obese women in relation to BMI and fracture risk found that even obese women with almost normal BMD had an elevated risk of fracture compared with obese women with higher BMD scores, 32 , suggesting that BMI does not always relate to fracture risk. Whether BMD is a predictor of fracture risk is still debatable.…”

Section: Impact Of Obesity On Musculoskeletal Tissue Systemsmentioning

confidence: 99%

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

Frechette

Krishnamoorthy

Pamon

et al. 2017

Annals of the New York Academy of Sciences

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The incidence of obesity is rapidly rising, increasing morbidity and mortality rates worldwide. Associated comorbidities include type 2 diabetes, heart disease, fatty liver disease, and cancer. The impact of excess fat on musculoskeletal health is still unclear, although it is associated with increased fracture risk and a decline in muscular function. The complexity of obesity makes understanding the etiology of bone and muscle abnormalities difficult. Exercise is an effective and commonly prescribed non-pharmacological treatment option, but it can be difficult or unsafe for the frail, elderly, and morbidly obese. Exercise alternatives, such as low-intensity vibration (LIV), have potential for improving musculoskeletal health, particularly in conditions with excess fat. LIV has been shown to influence bone marrow mesenchymal stem cell differentiation toward higher-order tissues (i.e., bone) and away from fat. While the exact mechanisms are not fully understood, recent studies utilizing LIV both at the bench and in the clinic have demonstrated its efficacy. Here, we discuss the current literature investigating the effects of obesity on bone, muscle, and bone marrow and how exercise and LIV can be used as effective treatments for combating the negative effects in the presence of excess fat.

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Women with severe obesity and relatively low bone mineral density have increased fracture risk

Abstract: Women with obesity who have the lowest BMD values, despite these being almost normal, have an elevated risk of fracture compared to those with higher BMD.

Cited by 29 publications

References 53 publications

Influence of body weight on bone mass, architecture and turnover

Influence of body weight on bone mass, architecture and turnover

The role of sex and body weight on the metabolic effects of high-fat diet in C57BL/6N mice

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

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