Aug 2026· Endocrinology and Metabolism· 0 citations· 23 references
Medicine
TL;DR
Patients with obesity demonstrated site-specific reductions in trabecular bone quality, particularly in the lower lumbar spine compared with non-obese people, suggesting that metabolic dysfunction, not mechanical loading, influences bone fragility in obesity.
Abstract
Background
Obesity has been considered protective against osteoporosis due to its association with higher bone mineral density (BMD). However, metabolic dysfunction, particularly insulin resistance (IR), may compromise bone quality even with BMD preserved.
Methods
This retrospective cross-sectional study (n=254) included 153 individuals with severe obesity undergoing bariatric metabolic surgery and 101 age- and sex-matched non-obese controls. BMD and trabecular bone score (TBS) were measured using dualenergy X-ray absorptiometry. A subgroup of participants with obesity was further analyzed to examine associations between IR, assessed using the homeostasis model assessment of insulin resistance (HOMA-IR), and bone parameters.
Results
BMD was significantly higher in the obese group, indicating preserved bone mass in obesity. But the proportions of spine-hip Z-score discordance was significant higher in the obese group (P=0.001). TBS displayed sitespecific findings: TBS at L1 was significantly higher in the obese group (P=0.002), whereas no significant differences were observed at L2-L4. Partially degraded or degraded TBS were higher in the obese group (P=0.021). Among participants with obesity, TBS decreased progressively across HOMA-IR quartiles (P=0.043), whereas BMD remained stable. In multivariable regression, higher HOMA-IR was independently associated with lower TBS (β=-0.0025; 95% confidence interval, -0.0043 to -0.0006; P=0.015), although this association was attenuated by hemoglobin A1c adjustment.
Conclusion
Patients with obesity demonstrated site-specific reductions in trabecular bone quality, particularly in the lower lumbar spine compared with non-obese people. IR was independently and inversely associated with TBS, suggesting that metabolic dysfunction, not mechanical loading, influences bone fragility in obesity. TBS represents a valuable adjunct to BMD for assessing skeletal health in metabolically impaired obese populations.
To investigate the association between the Metabolic Score for Insulin Resistance (METS-IR) and bone mineral density (BMD) and trabecular bone score (TBS) in adult cancer patients.
This cross-sectional study enrolled 127 patients (median age 63 years, 44.9% female) with histopathologically confirmed malignancies. BMD at the lumbar spine, femoral neck, and total hip and lumbar spine TBS were measured by dual-energy X-ray absorptiometry. METS-IR was calculated using fasting glucose, triglycerides, high-density lipoprotein cholesterol, and body mass index. Multivariable linear regression was used to identify independent associations.
After adjustment for confounders, METS-IR was independently and positively associated with BMD at lumbar spine (β = 0.006, 95% CI 0.002–0.011, P = 0.007), femoral neck (β = 0.007, 95% CI 0.003–0.011, P < 0.001), and total hip (β = 0.007, 95% CI 0.003–0.010, P < 0.001). Age was inversely associated with lumbar spine and femoral neck BMD, but not with total hip BMD; bone metastasis was linked to higher lumbar spine and total hip BMD. In contrast, METS-IR showed no significant association with lumbar spine TBS (P = 0.374). For TBS, age and male sex, but not METS-IR, were independent determinants.
In cancer patients, higher METS-IR is independently associated with greater BMD but not with better trabecular microarchitecture. This discordance between bone quantity and quality suggests that insulin resistance may mask impaired bone quality despite preserved BMD. Clinicians should consider bone quality assessments when evaluating fracture risk in metabolically compromised cancer patients. Longitudinal studies are warranted to confirm these findings.
Hong-Dan Yao, Cheng Niu, Lin Zhu et al.· Frontiers in Endocrinology· 0 citations
In postmenopausal women, higher BMI was associated with higher BMD but lower TBS, supporting a divergent relationship between densitometric findings and DXA-derived trabecular texture parameters, and suggesting that TBS may complement BMD in describing skeletal imaging status in overweight and obese women.
Osteoporosis and osteopenia, prevalent metabolic bone disorders, increase fracture risk, particularly in postmenopausal women. Chronic inflammation may contribute to bone loss. The association between inflammatory indices and bone mineral density (BMD) was investigated.
A cross-sectional analysis involving 99 patients over the age of 40 at the Ilam Rheumatology Clinic (2019–2022) evaluated BMD using the Hologic Discovery Wi DXA and assessed blood indices with the Sysmex XN-1000. Statistical analyses, including T-tests, ANOVA, and Pearson’s correlation, were conducted utilizing SPSS version 16, with significance set at
P
< 0.05.
Among 99 patients (78.8% female, mean age 55.8 ± 9.7 years), the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) exhibited significant elevation in cases of osteoporosis (2.710 ± 0.610,
P
= 0.001) and osteopenia (2.230 ± 0.530,
P
= 0.001) than in normal BMD (1.840 ± 0.450). The BMD exhibited a negative correlation with the NLR (
r
= –0.430,
P
= 0.001) and the PLR (
r
= –0.370,
P
= 0.002). Patients with osteoporosis exhibited the lowest bone mineral density in the lumbar spine (
P
< 0.001).
Increased levels of NLR and PLR correlate with diminished BMD, suggesting their potential as cost-effective biomarkers for osteoporosis risk assessment. Monitoring these indices could enhance early diagnosis and prevention strategies in at-risk populations.
Nasrin Bazgir, MohammadHossein Sahami Gilan, Aliashraf Mozafari et al.· Journal of Education and Hea...· 0 citations
The findings suggest that the clinical role of TBS in the assessment of pediatric bone health remains to be established, and that larger prospective studies are needed to clarify the clinical value of TBS for fracture risk assessment in pediatric autoimmune gastrointestinal diseases.
Anna Łupińska, Sara Aszkiełowicz, Arkadiusz Zygmunt et al.· Nutrients· 0 citations
Older people with osteopenia, osteoporosis and fracture had lower visceral fat mass, lean mass, lean mass and waist circumference than normal people and LM, WC and VFM had the greatest effect on BMD and fracture in elderly diabetic.
Seyed Amirhossein Hosseini, N. Meftah, Mansor Babaei et al.· Caspian Journal of Internal...· 0 citations
Aim: The cardiovascular-kidney-metabolic (CKM) syndrome highlights the interplay among cardiovascular, renal, and metabolic disorders. However, its relationship with the trabecular bone score (TBS) and bone mineral density (BMD) remains unclear. We aimed to evaluate the association between the CKM syndrome stage and bone health-related indicators.
Methods: Data from the 2005-2008 National Health and Nutrition Examination Survey were analyzed for 4,364 adults aged 30-79 years (median age 51 years; 51.9% male, 48.1% female). Bone health was assessed using TBS, femoral neck (FN) BMD, and lumbar spine (LS) BMD. Multivariate and segmented regression models were used to examine associations between CKM stages and TBS, FN BMD, and LS BMD.
Results: Multivariate linear regression revealed a significant inverse correlation between CKM syndrome stage and TBS, which was predominantly observed across the early stages (0-2), while positive correlations were observed with FN BMD and LS BMD. No significant associations were found between CKM syndrome stage and osteoporosis or prior fractures.
Conclusion: This study revealed a previously unrecognized dissociation in CKM syndrome, in which advanced stages were associated with a lower overall TBS despite higher FN BMD and LS BMD. This discordant pattern parallels the well-established diabetic bone paradox, underscoring the insufficiency of BMD alone for fracture risk assessment in patients with CKM syndrome. A comprehensive evaluation incorporating the TBS is essential to accurately assess bone fragility. Concurrent TBS assessment during routine BMD testing is recommended for patients with early-stage CKM to enable early detection of microarchitectural deficits.
Jiashuang Lin, Weifeng Chen, Xiaoyu Hong et al.· Metabolism and Target Organ...· 0 citations
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