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Adipopenia is associated with osteoporosis in community-dwelling non-underweight adults independent of sarcopenia

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Abstract

Summary

The effect of fat deficit on bone metabolism is understudied. This study showed that low body fat percent (adipopenia) in non-underweight community adults was associated with elevated odds of osteoporosis independent of low lean mass, highlighting potential clinical importance of adipopenia as an osteoporosis risk factor particularly in older adults.

Purpose

Although underweight is risk factor for osteoporosis, the association of low body fat percent (adipopenia) with osteoporosis in non-underweight adults remains unclear.

Methods

Among individuals aged ≥ 50 years with body mass index ≥ 18.5 kg/m2 in the Korean National Health and Nutrition Examination Survey 2008–2011, appendicular lean mass (ALM) and body fat percent (BFP) were measured using dual-energy x-ray absorptiometry. Low lean mass was defined as ALM/height2 < 7.0 kg/m2 and < 5.4 kg/m2 in men and women, respectively. Osteoporosis was defined as a bone mineral density (BMD) T-score ≤ -2.5 at the lumbar spine, femoral neck, or total hip. Participants were grouped into adipopenia (BFP < 17% in men; < 30%, in women; 1 standard deviation below the mean), normal, and obesity (BFP > 30% in men; > 40% in women) groups.

Results

Of the 5,830 participants (women 50.2%, mean age 63.9 years), 793 had adipopenia. The adipopenia group had a higher prevalence of osteoporosis (31%) than the normal (21%) or obesity groups (27%; p < 0.001). The presence of adipopenia was associated with 61% elevated odds of prevalent osteoporosis (p < 0.001) independent of low lean mass and covariates, which remained robust using different thresholds for adipopenia. Individuals with adipopenia and low lean mass had 3.5-fold elevated odds of osteoporosis compared to those with normal lean mass and fat percent. The association between adipopenia and osteoporosis was stronger in older women compared to middle-aged women (OR 1.93 vs. 0.99, P for interaction = 0.023).

Conclusion

Adipopenia was associated with osteoporosis in non-underweight adults, independent of low lean mass and covariates.

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Data availability

The original data are publicly available on the KNHANES website (https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do).

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Funding

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: RS-2021-KD000010).

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Author notes

  1. Seunghyun Lee and Kyoungmyoung Ko contributed equally to this work

Authors and Affiliations

  1. Department of Internal Medicine, Severance Hospital, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea

    Seunghyun Lee, Sungjae Shin, Namki Hong & Yumie Rhee

  2. Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, South Korea

    Seunghyun Lee

  3. Yonsei University College of Medicine, Seoul, Korea

    Kyoungmyoung Ko

  4. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Hye Sun Park

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Contributions

Conceptualization: Seunghyun Lee, Kyoungmyoung Ko, Hye Sun Park, and Namki Hong; Methodology: Seunghyun Lee, Kyoungmyoung Ko, Sungjae Shin, and Namki Hong; Formal analysis and investigation: Seunghyun Lee, Kyoungmyoung Ko, Sungjae Shin, and Namki Hong; Writing – original draft preparation: Seunghyun Lee and Kyoungmyoung Ko; Resources: Namki Hong and Yumie Rhee; Supervision: Namki Hong, Hye Sun Park, and Yumie Rhee.

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Correspondence to Namki Hong.

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Conflicts of interest

Yumie Rhee has served as a consultant for Amgen and has received honorarium from Amgen. Seunghyun Lee, Kyoungmyoung Ko, Sungjae Shin, Hye Sun Park, and Namki Hong have no relevant disclosures.

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Lee, S., Ko, K., Shin, S. et al. Adipopenia is associated with osteoporosis in community-dwelling non-underweight adults independent of sarcopenia. Arch Osteoporos 18, 44 (2023). https://doi.org/10.1007/s11657-023-01233-x

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