Relationship between Visceral Adipose Tissue and Bone Mineral Density in Older People: Results from AHAP Study

Osteoporosis is a chronic and common disease in the world, the most important consequence of which is bone fracture. Despite the existence of preventive treatments for osteoporosis, a large number of cases, especially among the elderly, remains undiagnosed or untreated1.

Numerous factors affect bone mineral density in the elderly, including age, gender, hypercortisolism, hyperthyroidism, hyperparathyroidism, hypogonadism, amenorrhea, alcohol use and smoking, immobility, white race, high corticosteroid use, previous fracture history, Vitamin D deficiency, and low BMI2.

Among the Aforementioned factors, the positive effect of BMI on bone mineral density and reduction of fractures in the elderly has been shown in a number of studies3,4, although in other studies the risk of fractures was higher in people with higher BMI5,6. Adipose tissue, including visceral fat and subcutaneous fat, which is an important component of body weight, may increase bone mineral density due to mechanical load on bone that results in stimulation of ossification7, conversion of androgen to estrogen in adipose tissue, lower level of sex hormone binding globulin (SHBG)8, increase in serum leptin level9, increase in the production of insulin growth factor and hyperinsulinemia10. Unlike the main function of subcutaneous fat tissue that is energy storage; visceral fat cells are metabolically active and have an effect on a wide range of clinical risk factors such as triglycerides, serum cholesterol and fasting blood sugar11.

Numerous epidemiological studies have been performed on the relationship between visceral adipose tissue (VAT) and bone mineral density indicating different results. In some of these studies12,13, VAT was negatively correlated with BMD, while such a correlation was not observed in other studies14, 15, 16 and in only one study, it was positively associated with BMD in children and adolescents17. Due to the high prevalence of osteoporosis in the elderly, the importance of VAT as an endocrine gland and the inconsistency of the results of studies, the present study was conducted to evaluate the relationship between VAT and BMD in the elderly.

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