Abstract
Diseases of compromised glucose metabolism, such as type II diabetes, have been for years correlated with defects in bone mass or strength. However, a reverse regulation of energy homeostasis by the skeleton was not suspected until very recently. A series of genetic studies have demonstrated that the skeleton regulates glucose metabolism and energy expenditure in an endocrine manner. The bone-derived protein osteocalcin acts as a hormone that confers the signal of the osteoblasts to the peripheral tissues that regulate energy metabolism: pancreas, muscle, liver, and white adipose tissue. Osteocalcin favors β-cell proliferation, insulin secretion, insulin sensitivity, and energy expenditure. In addition, insulin signaling in osteoblasts is a positive regulator of osteocalcin production and activity, confirming the existence of a pancreas-bone feedback loop. At the molecular level, two transcription factors, the broadly expressed FoxO1 and the osteoblast-enriched ATF4, act in osteoblasts to regulate energy homeostasis by regulating the activity of osteocalcin. In addition to studies in rodents, a growing body of evidence in the clinical literature has confirmed a favorable link between osteocalcin and energy homeostasis, suggesting that the metabolic functions of the skeleton are retained in humans.
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