Department of Endocrinology and Diabetes, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom.
Unit of Reproductive Endocrinology, 1st Department of Obstetrics & Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
J Musculoskelet Neuronal Interact. 2020 Sep 1;20(3):372-381.
Obesity and osteoporosis have become major global health problems over the last decades as their prevalence is increasing. The interaction between obesity and bone metabolism is complex and not fully understood. Historically, obesity was thought to be protective against osteoporosis;however, several studies have challenged this belief. Even though the majority of the studies suggest that obesity has a favourable effect on bone density, it is unclear what the effect of obesity is on skeletal microarchitecture. Additionally, the effects of obesity on skeletal strength might be site-dependent as obese individuals are at higher risk of certain fractures. Several mechanical, biochemical and hormonal mechanisms have been proposed to explain the association between the adipose tissue and bone. Mechanical loading has positive effects on bone health, but this may not suffice in obesity. Low-grade systemic inflammation is probably harmful to the bone and increased bone marrow adipogenesis may lead to decreased bone mass in obese individuals. Finally, visceral abdominal fat may exert different actions to the bone compared with the subcutaneous fat. Achieving a better understanding of the association between adipose and bone tissue may help to identify new molecular therapeutic targets that will promote osteoblastic activity and/or inhibit adipogenesis and osteoclastic activity.
在过去几十年中，肥胖症和骨质疏松症已成为全球主要的健康问题，因为它们的患病率在不断增加。肥胖症和骨代谢之间的相互作用非常复杂，目前尚未完全了解。历史上，人们认为肥胖症对骨质疏松症具有保护作用；然而，多项研究对此观点提出了质疑。尽管大多数研究表明肥胖症对骨密度有有利影响，但肥胖症对骨骼微观结构的影响尚不清楚。此外，肥胖症对骨骼强度的影响可能因部位而异，因为肥胖者更容易发生某些骨折。已经提出了几种机械、生化和激素机制来解释脂肪组织和骨骼之间的关联。机械负荷对骨骼健康有积极影响，但在肥胖症中可能还不够。低度全身炎症可能对骨骼有害，而增加骨髓脂肪生成可能导致肥胖个体的骨量减少。最后，内脏腹部脂肪可能对骨骼的作用与皮下脂肪不同。更好地了解脂肪组织和骨骼组织之间的关联可能有助于确定新的分子治疗靶点，从而促进成骨细胞活性和/或抑制脂肪生成和破骨细胞活性。
