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Osteoporosis and Bone Marrow Adipose Tissue

  • Bone Marrow and Adipose Tissue (B Lecka-Czernik and G Duque, Section Editors)
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Abstract

Purpose of Review

This review focuses on the recent findings regarding bone marrow adipose tissue (BMAT) concerning bone health. We summarize the variations in BMAT in relation to age, sex, and skeletal sites, and provide an update on noninvasive imaging techniques to quantify human BMAT. Next, we discuss the role of BMAT in patients with osteoporosis and interventions that affect BMAT.

Recent Findings

There are wide individual variations with region-specific fluctuation and age- and gender-specific differences in BMAT content and composition. The Bone Marrow Adiposity Society (BMAS) recommendations aim to standardize imaging protocols to increase comparability across studies and sites. Water-fat imaging (WFI) seems an accurate and efficient alternative for spectroscopy (1H-MRS). Most studies indicate that greater BMAT is associated with lower bone mineral density (BMD) and a higher prevalence of vertebral fractures. The proton density fat fraction (PDFF) and changes in lipid composition have been associated with an increased risk of fractures independently of BMD. Therefore, PDFF and lipid composition could potentially be future imaging biomarkers for assessing fracture risk. Evidence of the inhibitory effect of osteoporosis treatments on BMAT is still limited to a few randomized controlled trials. Moreover, results from the FRAME biopsy sub-study highlight contradictory findings on the effect of the sclerostin antibody romosozumab on BMAT.

Summary

Further understanding of the role(s) of BMAT will provide insight into the pathogenesis of osteoporosis and may lead to targeted preventive and therapeutic strategies.

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Abbreviations

BMAT:

bone marrow adipose tissue

BMSCs:

bone marrow stromal cells

BMAds:

bone marrow adipocytes

18F FDG-PET:

positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro- D-glucose

MRI:

magnetic resonance imaging

1H-MRS:

proton magnetic resonance spectroscopy

WFI:

water-fat imaging

BMAS:

international bone marrow adiposity society

DXA:

dual-energy X-ray absorptiometry

BMD:

bone mineral density

BMAd.Dm:

bone marrow adipocyte diameter

CT:

computed tomography

CSE-WFI:

chemical shift encoding-based water-fat imaging

BMFF:

bone marrow fat fraction

SFF:

signal fat fraction

PDFF:

proton density fat fraction

PRESS:

point-resolved spectroscopy

STEAM:

stimulated echo acquisition mode

DECT:

dual energy computed tomography

SAT:

subcutaneous adipose tissue

VAT:

visceral adipose tissue

ZOL:

zoledronic acid

RCT:

randomized clinical trial

Ad.V/TV:

adipose tissue volume/total tissue volume

N.Ad/Ma.Ar:

adipocyte number

PPARγ2 :

peroxisome proliferator-activated receptor γ2 gene

References

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Acknowledgements

- Sapienza University (RM118164289636F0) to AC. - START UP Research programme by Institute of Physiology and the Czech Science Foundation GACR 20-03586S, GACR 22-12243S, EFSD/NovoNordisk foundation Future leaders award (NNF20SA0066174), National Institute for Research of Metabolic and Cardiovascular Diseases (Programme EXCELES, ID Project No. LX22NPO5104) - Funded by the European Union – Next Generation EU to MT.

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Julien Paccou and Peter Bisschop had the idea for the article. All authors contributed to the literature search, data analysis, draft and critical revision of the manuscript.

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Beekman, K.M., Duque, G., Corsi, A. et al. Osteoporosis and Bone Marrow Adipose Tissue. Curr Osteoporos Rep 21, 45–55 (2023). https://doi.org/10.1007/s11914-022-00768-1

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