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Obesity, diabetes and risk of bone fragility: How BMAT behavior is affected by metabolic disturbances and its influence on bone health

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Abstract

Purpose

Osteoporosis is a metabolic bone disease characterized by decreased bone strength and mass, which predisposes patients to fractures and is associated with high morbidity and mortality. Like osteoporosis, obesity and diabetes are systemic metabolic diseases associated with modifiable risk factors and lifestyle, and their prevalence is increasing. They are related to decreased quality of life, functional loss and increased mortality, generating high costs for health systems and representing a worldwide public health problem. Growing evidence reinforces the role of bone marrow adipose tissue (BMAT) as an influential factor in the bone microenvironment and systemic metabolism. Given the impact of obesity and diabetes on metabolism and their possible effect on the bone microenvironment, changes in BMAT behavior may explain the risk of developing osteoporosis in the presence of these comorbidities.

Methods

This study reviewed the scientific literature on the behavior of BMAT in pathological metabolic conditions, such as obesity and diabetes, and its potential involvement in the pathogenesis of bone fragility.

Results

Published data strongly suggest a relationship between increased BMAT adiposity and the risk of bone fragility in the context of obesity and diabetes.

Conclusion

By secreting a broad range of factors, BMAT modulates the bone microenvironment and metabolism, ultimately affecting skeletal health. A better understanding of the relationship between BMAT expansion and metabolic disturbances observed in diabetic and obese patients will help to identify regulatory pathways and new targets for the treatment of bone-related diseases, with BMAT as a potential therapeutic target.

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  1. Department of Veterinary Medicine, Federal University of Lavras, Lavras, Minas Gerais, Brazil

    Gregório Corrêa Guimarães, João Bosco Costa Coelho, João Gabriel Oliveira Silva & Ana Carolina Chalfun de Sant’Ana

  2. Department of Medicine, Federal University of Lavras, Lavras, Minas Gerais, Brazil

    Cássia Alves Carrilho de Sá, Júlia Marques Moreno, Lívia Marçal Reis & Camila Souza de Oliveira Guimarães

  3. Departamento de Medicina, Universidade Federal de Lavras, Câmpus Universitário, Caixa Postal 3037, CEP 37200-900, Lavras, Minas Gerais, Brasil

    Camila Souza de Oliveira Guimarães

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Guimarães, G.C., Coelho, J.B.C., Silva, J.G.O. et al. Obesity, diabetes and risk of bone fragility: How BMAT behavior is affected by metabolic disturbances and its influence on bone health. Osteoporos Int 35, 575–588 (2024). https://doi.org/10.1007/s00198-023-06991-5

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