Abstract
The protective effect of obesity on bone health has been challenged by studies that link visceral adiposity to poor bone microarchitecture in young obese men and women. In postmenopausal women, the role of visceral adipose tissue (VAT) on bone turnover markers (BTMs) has not been investigated. The aim was to investigate the impact of VAT on BTMs, total bone mineral density (BMD), vitamin D metabolites and parathyroid levels (1-84 PTH) levels in postmenopausal women. A total of 76 lean and overweight women (without osteoporosis) underwent VAT measurements by dual-energy X-ray absorptiometry (iDXA). Blood samples were analyzed for serum C-terminal telopeptide of type 1 collagen (CTX-1), osteocalcin, bone-specific alkaline phosphatase (bone ALP), 1–84 PTH and vitamin D (25 hydroxyvitamin D, 25(OH)D) levels. VAT volumes ranged from 91 to 3392 cm3 and body mass index (BMI) ranged from 18.3 to 53.9 kg/m2. Women in the highest VAT quartile had significantly lower CTX-1, 25(OH)D, osteocalcin and the highest BMD (p < 0.05, for all). While VAT positively associated with BMD, after controlling for BMI, VAT was a negative predictor of BMD (β = 0.368, p < 0.05). VAT was an independent negative predictor of CTX-1 (β = −0.263, p < 0.05) and osteocalcin levels (β = −0.277, p < 0.05). Among all measures of adiposity, VAT was the strongest independent determinant of BMD and BTMs. In clinical settings, VAT, and not BMI, may be a sensitive predictor of bone health in obese women.
Highlights
The impact of obesity on bone metabolism and risk of fractures has been of major interest, with considerable controversy and debate
To investigate the effect of visceral adipose tissue (VAT), participants were divided into VAT quartiles and their characteristics and biochemical profiles as per VAT quartiles are described in Tables 1 and 2, respectively
There was no difference in participant’s age across quartiles, body mass index (BMI) was normal in the first quartile (
Summary
The impact of obesity on bone metabolism and risk of fractures has been of major interest, with considerable controversy and debate. Obesity, when measured as body mass index (BMI), was thought to be protective for bone health, as individuals with a higher BMI usually have a higher bone mineral density (BMD) [1]. 3% [6], indicating that higher central or abdominal fat is associated with a higher risk of hip fracture. Consistent with this, studies using high resolution computed tomography (CT) imaging demonstrate that visceral adipose tissue (VAT) is more strongly associated with poor bone microarchitecture and reduced bone strength than other fat regions [7,8,9,10]. Abdominal subcutaneous adipose tissue (SAT) is reported to have no [11] or even protective effects on bone density and strength [8]. Bredella et al have reported in two separate cross-sectional studies that abdominal adiposity was a negative predictor of
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