Journal of Mid-life Health Journal of Mid-life Health
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Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 1-2  

Obesity, sarcopenia and postmenopausal osteoporosis: An interlinked triad!

Reproductive Endocrinologist and Director, Unit of Endocrine and Metabolic Disorders, Medical Research Centre of Kasturba Health Society, Mumbai, Maharashtra, India

Date of Web Publication24-Feb-2014

Correspondence Address:
Rama Vaidya
Reproductive Endocrinologist and Director, Unit of Endocrine and Metabolic Disorders, Medical Research Centre of Kasturba Health Society, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-7800.127778

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How to cite this article:
Vaidya R. Obesity, sarcopenia and postmenopausal osteoporosis: An interlinked triad!. J Mid-life Health 2014;5:1-2

How to cite this URL:
Vaidya R. Obesity, sarcopenia and postmenopausal osteoporosis: An interlinked triad!. J Mid-life Health [serial online] 2014 [cited 2021 May 12];5:1-2. Available from:

Obesity has been conventionally, considered as protective toward bone health. Currently, this view is being challenged and obesity is considered as detrimental to bone health. In the present issue of Journal of Midlife Health, the author, whereas reviewing the epidemiological studies and pathophysiological mechanisms of obesity-related osteoporosis, emphasizes the emerging evidence about the adverse effect of obesity on bone health. [1] A positive relation has been shown of ectopic fat and serum lipids with bone marrow fat in young men and women. [2] A negative correlation has recently been shown between truncal fat (TF) and bone mineral density (BMD). [3] The authors also showed that a TF was directly related to insulin insensitivity and inflammatory cytokines. [3] Prevalence of metabolic syndrome (MS), known to be strongly associated with insulin resistance (IR) and inflammatory cytokines, is high amongst peri- and post-menopausal (PM) Indian women. [4],[5],[6] Obesity and MS, having common determinants such as IR and inflammatory cytokines, [7] would thus (probably) be closely associated with osteoporosis in a large number of PM Indian women. The first question then one would want to ask is what would be the bone health in metabolically healthy obese (MHO) PM women? One wonders if the earlier observation of obesity being protective toward bone health had emerged because the individuals observed were MHO.

The second question to be asked is whether skeletal muscles play any role in this obesity-related osteoporosis. In a comparative cross-sectional study of PM women with and without osteoporosis, a reduction in muscle strength (back flexor and extensor strength) was observed in women with osteoporosis as compared to those without osteoporosis. [8] A significant correlation existed between appendicular skeletal muscle (ASM) mass relative to height and trabecular as well as cortical bone geometry and microstructure. The authors find low levels of insulin-like growth factor-binding protein 2 in relation with low relative ASM in men and women similar to the low levels earlier they reported with low BMD and high bone resorption markers. How does ASM exert its influence on bone or vice a versa? It is only recently that muscle is being recognized as an endocrine organ that secretes myokines. [9] Mark Hemrick has hypothesized and provided some evidence for muscle-secreted factors (myokines) that influence bone health via endocrine and paracrine pathways besides ASM exerting its mechanical influence on the bone mass. [10],[11] Their group have identified several osteogenic myokines such as insulin-like growth factor-1 and fibroblast growth factor-2 at the muscle-bone interface that participates in bone formation. Myostatin, an anti-ostogenic myokine, exerts inhibitory effect on the muscle and causes bone loss. Myostatin-inhibitors induce increase in muscle mass and bone density and loss of fat. [12] However, human data are sparse and more studies are required to assess the clinical application of myostatin-inhibitors in management of sarcopenic obesity and associated cardiometabolic dysfunction. Similarly, growth hormone-releasing hormone analogues have also been proposed as possible therapy for Sarcopenic Obesity (SO) group. [13]

Meanwhile, it is important that we identify women with sarco-obese osteoporotic postmenopausal women and offer them a well-tailored energy-restricted, high protein diet with resistance exercise program. [14],[15],[16]

   References Top

1.Tandon VR. Obesity: Friend or foe for osteoporosis (obesity of bone). J Midlife Health 2013;6:6-9.  Back to cited text no. 1
2.Bredella MA, Gill CM, Gerweck AV, Landa MG, Kumar V, Daley SM, et al. Ectopic and serum lipid levels are positively associated with bone marrow fat in obesity. Radiology 2013;269:534-41.  Back to cited text no. 2
3.Greco EA, Francomano D, Fornari R, Marocco C, Lubrano C, Papa V, et al. Negative association between trunk fat, insulin resistance and skeleton in obese women. World J Diabetes 2013;4:31-9.  Back to cited text no. 3
4.Dasgupta S, Salman M, Lokesh S, Xaviour D, Saheb SY, Prasad BV, et al. Menopause versus aging: The predictor of obesity and metabolic aberrations among menopausal women of Karnataka, South India. J Midlife Health 2012;3:24-30.  Back to cited text no. 4
5.Pandey S, Srinivas M, Agashe S, Joshi J, Galvankar P, Prakasam CP, et al. Menopause and metabolic syndrome: A study of 498 urban women from western India. J Midlife Health 2010;1:63-9.  Back to cited text no. 5
6.Jesmin S, Islam AS, Akter S, Islam MM, Sultana SN, Yamaguchi N, et al. Metabolic syndrome among pre- and post-menopausal rural women in Bangladesh: Result from a population-based study. BMC Res Notes 2013;6:157.  Back to cited text no. 6
7.Bastard JP, Maachi M, Lagathu C, Kim MJ, Caron M, Vidal H, et al. Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur Cytokine Netw 2006;17:4-12.  Back to cited text no. 7
8.Cunha-Henriques S, Costa-Paiva L, Pinto-Neto AM, Fonsechi-Carvesan G, Nanni L, Morais SS. Postmenopausal women with osteoporosis and musculoskeletal status: A comparative cross-sectional study. J Clin Med Res 2011;3:168-76.  Back to cited text no. 8
9.Pedersen BK. Edward F. Adolph distinguished lecture: Muscle as an endocrine organ: IL-6 and other myokines. J Appl Physiol (1985) 2009;107:1006-14.  Back to cited text no. 9
10.Mark W, Hamrick A. Role for myokines in muscle-bone interactions. Exerc Sport Sci Rev 2011;39:43-7.  Back to cited text no. 10
11.Hamrick MW. The skeletal muscle secretome: An emerging player in muscle-bone crosstalk. Bonekey Rep 2012;1:60.  Back to cited text no. 11
12.Buehring B, Binkley N. Myostatin - The holy grail for muscle, bone, and fat? Curr Osteoporos Rep 2013;11:407-14.  Back to cited text no. 12
13.Bouchonville MF, Villareal DT. Sarcopenic obesity: How do we treat it? Curr Opin Endocrinol Diabetes Obes 2013;20:412-9.  Back to cited text no. 13
14.Lu CW, Yang KC, Chang HH, Lee LT, Chen CY, Huang KC. Sarcopenic obesity is closely associated with metabolic syndrome. Obes Res Clin Pract 2013;7:e235-320.  Back to cited text no. 14
15.Binkley N, Buhring H. Beyond FRAX: it's time to consider "sarco-osteopenia". J Clin Densitom 2009;12:413-6.  Back to cited text no. 15
16.Benton MJ, Whyte MD, Dyal BW. Sarcopenic obesity: Strategies for management. Am J Nurs 2011;111:38-44.  Back to cited text no. 16


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