The obesity paradox and osteoporosis
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”.
KeywordsObesity paradox Osteoporosis Bone metabolism Bone mineral density and obesity
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Conflict of interest
The authors state that there is no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
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- 2.Hernlund E, Svedbom A, Ivergård M et al (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. https://doi.org/10.1007/s11657-013-0136-1 CrossRefPubMedPubMedCentralGoogle Scholar
- 3.Kanis JA, Cooper C, Rizzoli R et al (2017) Identification and management of patients at increased risk of osteoporotic fracture: outcomes of an ESCEO expert consensus meeting. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 28:2023–2034. https://doi.org/10.1007/s00198-017-4009-0 CrossRefGoogle Scholar
- 4.WHO | Obesity and overweight. In: WHO. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 24 Nov 2017
- 11.Garnero P, Sornay-Rendu E, Claustrat B, Delmas PD (2000) Biochemical markers of bone turnover, endogenous hormones and the risk of fractures in postmenopausal women: the OFELY study. J Bone Miner Res Off J Am Soc Bone Miner Res 15:1526–1536. https://doi.org/10.1359/jbmr.2000.15.8.1526 CrossRefGoogle Scholar
- 26.Pritchard JM, Giangregorio LM, Atkinson SA et al (2013) Changes in trabecular bone microarchitecture in postmenopausal women with and without type 2 diabetes: a two year longitudinal study. BMC Musculoskelet Disord 14:114. https://doi.org/10.1186/1471-2474-14-114 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Leslie WD, Morin SN, Lix LM, Majumdar SR (2014) Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture? Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 25:2817–2824. https://doi.org/10.1007/s00198-014-2822-2 CrossRefGoogle Scholar
- 37.Sornay-Rendu E, Boutroy S, Vilayphiou N et al (2013) In obese postmenopausal women, bone microarchitecture and strength are not commensurate to greater body weight: the Os des Femmes de Lyon (OFELY) study. J Bone Miner Res Off J Am Soc Bone Miner Res 28:1679–1687. https://doi.org/10.1002/jbmr.1880 CrossRefGoogle Scholar
- 38.Chang C-S, Chang Y-F, Wang M-W et al (2013) Inverse relationship between central obesity and osteoporosis in osteoporotic drug naive elderly females: the Tianliao Old People (TOP) Study. J Clin Densitom Off J Int Soc Clin Densitom 16:204–211. https://doi.org/10.1016/j.jocd.2012.03.008 CrossRefGoogle Scholar
- 45.Lang T, Cauley JA, Tylavsky F et al (2010) Computed tomographic measurements of thigh muscle cross-sectional area and attenuation coefficient predict hip fracture: the health, aging, and body composition study. J Bone Miner Res Off J Am Soc Bone Miner Res 25:513–519. https://doi.org/10.1359/jbmr.090807 CrossRefGoogle Scholar
- 47.Scott D, Chandrasekara SD, Laslett LL et al (2016) Associations of sarcopenic obesity and dynapenic obesity with bone mineral density and incident fractures over 5–10 years in community-dwelling older adults. Calcif Tissue Int 99:30–42. https://doi.org/10.1007/s00223-016-0123-9 CrossRefPubMedGoogle Scholar
- 49.Perna S, Peroni G, Faliva MA et al (2017) Sarcopenia and sarcopenic obesity in comparison: prevalence, metabolic profile, and key differences. A cross-sectional study in Italian hospitalized elderly. Aging Clin Exp Res 29:1249–1258. https://doi.org/10.1007/s40520-016-0701-8 CrossRefPubMedGoogle Scholar
- 54.Ardawi M-SM, Qari MH, Rouzi AA et al (2011) Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 22:463–475. https://doi.org/10.1007/s00198-010-1249-7 CrossRefGoogle Scholar