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Abdominal Fat Is Associated With Lower Bone Formation and Inferior Bone Quality in Healthy Premenopausal Women: A Transiliac Bone Biopsy Study
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CONTEXT: The conventional view that obesity is beneficial for bone strength has recently been challenged by studies that link obesity, particularly visceral obesity, to low bone mass and fractures. It is controversial whether effects of obesity on bone are mediated by increased bone resorption or decreased bone formation. OBJECTIVE: The objective of the study was to evaluate bone microarchitecture and remodeling in healthy premenopausal women of varying weights. DESIGN: We measured bone density and trunk fat by dual-energy x-ray absorptiometry in 40 women and by computed tomography in a subset. Bone microarchitecture, stiffness, remodeling, and marrow fat were assessed in labeled transiliac bone biopsies. RESULTS: Body mass index (BMI) ranged from 20.1 to 39.2 kg/m(2). Dual-energy x-ray absorptiometry-trunk fat was directly associated with BMI (r = 0.78, P < .001) and visceral fat by computed tomography (r = 0.79, P < .001). Compared with women in the lowest tertile of trunk fat, those in the highest tertile had inferior bone quality: lower trabecular bone volume (20.4 ± 5.8 vs 29.1 ± 6.1%; P = .001) and stiffness (433 ± 264 vs 782 ± 349 MPa; P = .01) and higher cortical porosity (8.8 ± 3.5 vs 6.3 ± 2.4%; P = .049). Bone formation rate (0.004 ± 0.002 vs 0.011 ± 0.008 mm(2)/mm · year; P = .006) was 64% lower in the highest tertile. Trunk fat was inversely associated with trabecular bone volume (r = -0.50; P < .01) and bone formation rate (r = -0.50; P < .001). The relationship between trunk fat and bone volume remained significant after controlling for age and BMI. CONCLUSIONS: At the tissue level, premenopausal women with more central adiposity had inferior bone quality and stiffness and markedly lower bone formation. Given the rising levels of obesity, these observations require further investigation.
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“While data are limited, obese patients may be at increased fracture risk, particularly at peripheral sites24-27.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [24]
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“Changes at the spine are more variable, some studies report small decreases 24, 54, 63, 67-69, while others have not 52, 53, 65, 66.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [24]
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Metadata
- Authors
- Cohen, A., Dempster, D. W., Recker, R. R., Lappe, J. M., Zhou, H., Zwahlen, A., Müller, R., Zhao, B., Guo, X., Lang, T., Saeed, I., Liu, X. S., Guo, X. E., Cremers, S., Rosen, C. J., Stein, E. M., Nickolas, T. L., McMahon, D. J., Young, P., & Shane, E.
- Affiliations
- Columbia University (US)
- Helen Hayes Hospital (US)
- Creighton University (US)
- ETH Zurich (CH)
- University of California, San Francisco (US)
- Maine Medical Center (US)
- Corresponding author
- Cohen, Adi
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2013-06-01
- Volume
- 98
- Issue
- 6
- Pages
- 2562-2572
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC3667251
- OpenAlex
- W2000962428
- Semantic Scholar
- 5b94125fc696b1fc9d9b43df52694c7fa3fe5caf
- Cited by
- 206
- References
- 75
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 9 · 2023: 16 · 2022: 20 · 2021: 17 · 2020: 13 · 2019: 15 · 2018: 13 · 2017: 24 · 2016: 16 · 2015: 18 · 2014: 20 · 2013: 6
- FWCI
- 20.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health (5k24ar052665-10)
- National Institute of Diabetes and Digestive and Kidney Diseases (R24DK092759)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24 AR05266, R01AR049896, K24-AR 052665, K23AR054127)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Health Sciences › Medicine › Infectious Diseases › HIV-related health complications and treatments
- Keywords
- abdominal fat, visceral obesity, bone formation rate, bone quality, bone microarchitecture, trabecular bone volume, cortical porosity, bone stiffness, bone remodeling, premenopausal women, abdominal obesity, bone mineral density
- MeSH terms
- Adolescent, Adult, Biopsy, Bone and Bones, Female, Humans, Insulin-Like Growth Factor I, Middle Aged, Osteogenesis, Regression Analysis, Absorptiometry, Photon, Bone Density, Body Mass Index, Premenopause, Abdominal Fat
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