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Relationship of Obesity with Osteoporosis

Departments of Orthopedic Surgery and Basic Medical Science (L.-J.Z., Y.-J.L., J.H., H.-W.D.), School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri 64108; Osteoporosis Research Center (L.-J.Z., P.-Y.L., R.R.R.), Creighton University Medical Center, Omaha, Nebraska 68131; Laboratory of Molecular and Statistical Genetics (H.-W.D.), College of Life Sciences, Hunan Normal University, Changsha, Hunan 410081, People’s Republic of China; and The Key Laboratory of Biomedical Information Engineering of Ministry of Education and Institute of Molecular Genetics (H.-W.D.), School of Life Science and Technology, Xi’an Jiaotong University, Xi’an 710049, People’s Republic of China

Address all correspondence and requests for reprints to: Hong-Wen Deng, Ph.D., Department of Basic Medical Science, School of Medicine, University of Missouri-Kansas City, 2411 Holmes Street, Room M3-CO3, Kansas City, Missouri 64108. E-mail: dengh{at}umkc.edu.

Context: The relationship between obesity and osteoporosis has been widely studied, and epidemiological evidence shows that obesity is correlated with increased bone mass. Previous analyses, however, did not control for the mechanical loading effects of total body weight on bone mass and may have generated a confounded or even biased relationship between obesity and osteoporosis.

Objective: The objective of this study was to reevaluate the relationship between obesity and osteoporosis by accounting for the mechanical loading effects of total body weight on bone mass.

Methods: We measured whole body fat mass, lean mass, percentage fat mass, body mass index, and bone mass in two large samples of different ethnicity: 1988 unrelated Chinese subjects and 4489 Caucasian subjects from 512 pedigrees. We first evaluated the Pearson correlations among different phenotypes. We then dissected the phenotypic correlations into genetic and environmental components with bone mass unadjusted or adjusted for body weight. This allowed us to compare the results with and without controlling for mechanical loading effects of body weight on bone mass.

Results: In both Chinese and Caucasian subjects, when the mechanical loading effect of body weight on bone mass was adjusted for, the phenotypic correlation (including its genetic and environmental components) between fat mass (or percentage fat mass) and bone mass was negative. Further multivariate analyses in subjects stratified by body weight confirmed the inverse relationship between bone mass and fat mass, after mechanical loading effects due to total body weight were controlled.

Conclusions: Increasing fat mass may not have a beneficial effect on bone mass.

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