Abstract
There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.
Highlights
Obesity represents a growing social problem, which leads to significant efforts by healthcare systems all over the world to avoid the serious consequences that it can have on health.Obesity, according to the World Health Organization’s (WHO) definition, is an abnormal or excessive fat accumulation that may impair health
There are numerous studies and reviews published on this topic [4–8], this review aims to be as complete as possible, examining all the facets related to this problem, broadening the discussion to the consequences of bariatric surgery and childhood obesity
It has been shown that older adults with sarcopenic obesity have higher percentage of nonvertebral fractures, compared with those with sarcopenia alone and those with obesity alone [218,219]. The reasons for this increased risk of fractures are the following: (1) the decreased bone strength, partly due to the age-related decrease of BMD [220,221] and, as we said earlier, to the action of myostatin [215,216] and to the worse bone quality connected with obesity [14–18]; (2) the greater risk of falling [213,222–225] connected to the muscular weakness of sarcopenia, postural instability and reduced physical activity [224] derived both from the condition of obesity and from that of sarcopenia [226] without forgetting that we are generally speaking of elderly patients, whose physical abilities are naturally reduced
Summary
Obesity represents a growing social problem, which leads to significant efforts by healthcare systems all over the world to avoid the serious consequences that it can have on health. If scientific evidence clarifies its significant role in increasing fracture risk, obesity could be included in the various algorithms that can be used to quantify fracture risk. This narrative review aims to carefully examine the literature on the influence that obesity has on bone health, both in children and adults, trying to clarify a topic that is still debated and remains partially controversial. The risk of fracture depends on bone fragility and the propensity for falls We will examine these two risk factors both in general and in obesity
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