Obesity, diabetes and risk of bone fragility: How BMAT behavior is affected by metabolic disturbances and its influence on bone health

• Published in: Osteoporosis international 2024-04, Vol.35 (4), p.575-588
• Main Authors: Guimarães, Gregório Corrêa, Coelho, João Bosco Costa, Silva, João Gabriel Oliveira, de Sant’Ana, Ana Carolina Chalfun, de Sá, Cássia Alves Carrilho, Moreno, Júlia Marques, Reis, Lívia Marçal, de Oliveira Guimarães, Camila Souza
• Format: Article
• Language: English
• Subjects: Adipose tissue; Adipose Tissue - pathology; Bone Density; Bone diseases; Bone Marrow - pathology; Bone mass; Bone strength; Comorbidity; Diabetes; Diabetes Mellitus; Endocrinology; Fractures; Humans; Medicine; Medicine & Public Health; Metabolic disorders; Metabolism; Morbidity; Mortality; Obesity; Obesity - complications; Obesity - pathology; Orthopedics; Osteoporosis; Osteoporosis - epidemiology; Osteoporosis - etiology; Osteoporosis - metabolism; Public health; Quality of Life; Review; Rheumatology; Risk factors; Therapeutic targets
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-023-06991-5

Purpose Osteoporosis is a metabolic bone disease characterized by decreased bone strength and mass, which predisposes patients to fractures and is associated with high morbidity and mortality. Like osteoporosis, obesity and diabetes are systemic metabolic diseases associated with modifiable risk factors and lifestyle, and their prevalence is increasing. They are related to decreased quality of life, functional loss and increased mortality, generating high costs for health systems and representing a worldwide public health problem. Growing evidence reinforces the role of bone marrow adipose tissue (BMAT) as an influential factor in the bone microenvironment and systemic metabolism. Given the impact of obesity and diabetes on metabolism and their possible effect on the bone microenvironment, changes in BMAT behavior may explain the risk of developing osteoporosis in the presence of these comorbidities. Methods This study reviewed the scientific literature on the behavior of BMAT in pathological metabolic conditions, such as obesity and diabetes, and its potential involvement in the pathogenesis of bone fragility. Results Published data strongly suggest a relationship between increased BMAT adiposity and the risk of bone fragility in the context of obesity and diabetes. Conclusion By secreting a broad range of factors, BMAT modulates the bone microenvironment and metabolism, ultimately affecting skeletal health. A better understanding of the relationship between BMAT expansion and metabolic disturbances observed in diabetic and obese patients will help to identify regulatory pathways and new targets for the treatment of bone-related diseases, with BMAT as a potential therapeutic target.