Purpose of Review
This review focuses on the recent findings regarding bone marrow adipose tissue (BMAT) concerning bone health. We summarize the variations in BMAT in relation to age, sex, and skeletal sites, and provide an update on noninvasive imaging techniques to quantify human BMAT. Next, we discuss the role of BMAT in patients with osteoporosis and interventions that affect BMAT.
There are wide individual variations with region-specific fluctuation and age- and gender-specific differences in BMAT content and composition. The Bone Marrow Adiposity Society (BMAS) recommendations aim to standardize imaging protocols to increase comparability across studies and sites. Water-fat imaging (WFI) seems an accurate and efficient alternative for spectroscopy (1H-MRS). Most studies indicate that greater BMAT is associated with lower bone mineral density (BMD) and a higher prevalence of vertebral fractures. The proton density fat fraction (PDFF) and changes in lipid composition have been associated with an increased risk of fractures independently of BMD. Therefore, PDFF and lipid composition could potentially be future imaging biomarkers for assessing fracture risk. Evidence of the inhibitory effect of osteoporosis treatments on BMAT is still limited to a few randomized controlled trials. Moreover, results from the FRAME biopsy sub-study highlight contradictory findings on the effect of the sclerostin antibody romosozumab on BMAT.
Further understanding of the role(s) of BMAT will provide insight into the pathogenesis of osteoporosis and may lead to targeted preventive and therapeutic strategies.
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bone marrow adipose tissue
bone marrow stromal cells
bone marrow adipocytes
- 18F FDG-PET:
positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose
magnetic resonance imaging
proton magnetic resonance spectroscopy
international bone marrow adiposity society
dual-energy X-ray absorptiometry
bone mineral density
bone marrow adipocyte diameter
chemical shift encoding-based water-fat imaging
bone marrow fat fraction
signal fat fraction
proton density fat fraction
stimulated echo acquisition mode
dual energy computed tomography
subcutaneous adipose tissue
visceral adipose tissue
randomized clinical trial
adipose tissue volume/total tissue volume
- PPARγ2 :
peroxisome proliferator-activated receptor γ2 gene
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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- Sapienza University (RM118164289636F0) to AC. - START UP Research programme by Institute of Physiology and the Czech Science Foundation GACR 20-03586S, GACR 22-12243S, EFSD/NovoNordisk foundation Future leaders award (NNF20SA0066174), National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union – Next Generation EU to MT.
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Beekman, K.M., Duque, G., Corsi, A. et al. Osteoporosis and Bone Marrow Adipose Tissue. Curr Osteoporos Rep 21, 45–55 (2023). https://doi.org/10.1007/s11914-022-00768-1
- Bone marrow adipose tissue
- Lipid composition
- Bone mineral density
- Clinical trials