What’s the Relationship Between Osteoporosis and Obesity?

Introduction

Obesity and osteoporosis are linked, and this relationship should not be disregarded. Heart disease, diabetes, and stroke are health issues that are frequently linked to being overweight.

Mineral density and bone strength declines are hallmarks of osteoporosis, a bone disease. Over 200 million people worldwide are impacted, and those who are assigned female at birth are more likely to have it.

A person of any age can be diagnosed with osteoporosis, despite the fact that it is frequently thought of as a disorder that primarily affects the elderly.

Although research indicates that this may also be true at the other extreme, low body mass index (BMI) has historically been linked to an increased risk of osteoporosis.

Although new research has indicated a possible link between obesity and osteoporosis, researchers are unsure of the precise relationship between fat and bone density.

Nearly 30% of individuals with osteoporosis are overweight or obese, despite the prior belief that obesity protects against osteoporosis. Low-impact exercises may increase the risk of fractures in obese individuals with osteoporosis.

Obesity and the Health of Bones

The long-held belief that larger weights indicate stronger bones is gradually being refuted. Numerous elements are involved when an individual is overweight and what that means for their capacity to maintain good bone health, according to recent assessments of the literature on obesity and bone health.

In order to address the relationship between bone health and obesity, variables such as body weight, fat volume, bone creation and breakdown, fat in bone marrow, and inflammation brought on by immune cells (pro-inflammatory cytokines) must be considered.

Types of Fat

The three forms of fat are beige, white, and brown.

• The body uses brown fat, sometimes known as “good fat,” to help regulate its temperature.
• Health issues can be exacerbated by the accumulation of white fat in the body.
• Usually located close to the clavicle and spine, beige fat cells are derived from white fat.

White fat stores fat, but brown and beige fat can burn it.

One study looked at how adipokines, which are chemicals made by body fat, affect bone cells. The interaction between brown fat (the kind of fat that turns food into body heat), white fat in bone marrow, and the ongoing cycle of bone growth and breakdown (bone metabolism) was also examined in the article.

Although the exact nature of the relationship between fat and bone metabolism is still unclear, the results did indicate one. It is known that adipose tissue tries to control the health of the bones by interacting with them and producing specific cytokines.

The fat tissue found in bone marrow is also crucial for bone structure and density. According to the paper, it is difficult to pinpoint the precise reason why obesity affects bone health because it is frequently linked to nutritional imbalances (such as a deficiency in calcium, phosphorous, or vitamin D).

Misconceptions

Although it has long been believed that osteoporosis mainly affects elderly, fragile people, there are numerous factors that can increase the risk of developing the condition and its development.

Although osteoporosis is more common in older persons, particularly women, recent studies on the relationship between fat and osteoporosis have shown that frailty is not always a precondition for the disease.

Childhood Obesity

Numerous studies conducted throughout the years have revealed a complex association between childhood obesity and bone health.

A person’s childhood is when they build up about 25% of their bone mass. According to studies, childhood obesity may raise a child’s chance of developing osteoporosis and fractures as they age because it alters bone mass as the child grows.

In contrast to the widely held belief that larger children had better bone mineral density, it is believed that children who are obese have reduced bone mass.

Furthermore, it has been discovered that children who have less bone mass during their growth would also have less bone mass as adults, thereby increasing their chance of developing osteoporosis.

How Common Is Childhood Obesity?

Approximately 14.4 million children and adolescents in the United States suffer from obesity, making approximately 19.3% of the country’s total population of this age group, according to the Centers for Disease Control and Prevention.

The Causes of Obesity

The primary cause of obesity is consuming more calories than your body requires, whether through insufficient physical activity to burn the extra calories or by eating more than your body requires for energy.

However, obesity can develop due to a variety of circumstances, such as:

• Using tobacco products or other chemicals
• The age of
• Some drugs or medical disorders (such as antidepressants or polycystic ovary syndrome)
• Response of the genome to environmental changes
• Food promotion and marketing in one’s community
• Insufficient knowledge on healthy eating habits
• Not knowing how to cook wholesome meals
• Community elements that could make it unsafe to walk, such as a lack of bike lanes or sidewalks
• Social considerations or constraints (such as a dearth of information about healthy behaviors and routines)

Reasons for Osteoporosis

The causes of obesity and osteoporosis are somewhat similar. Both osteoporosis and obesity can be made more likely by smoking, not getting enough weight-bearing activity, becoming older, eating poorly, and taking certain drugs and medical conditions.

A few further known risk factors for osteoporosis include:

• Insufficient amounts of estrogen
• Absence of calcium and vitamin D in the diet
• A sedentary way of life

Can Obesity Increase the Risk of Osteoporosis?

Osteoporosis is a disorder that weakens bones, increasing their susceptibility to fracture. On a global scale, it impacts millions of individuals and is more prevalent as people age and adopt unhealthy lifestyle choices like not exercising.

Regarding the link between fat and osteoporosis, there has been significant debate among researchers.

It was once thought that because of the higher mechanical pressures that excess body mass can exert on the skeleton, obesity might potentially be a prophylactic measure against osteoporosis. It has also been proposed that the excess adipose tissue could act as a cushion during falls, preventing some fractures.

A growing amount of data, however, indicates that obesity increases the risk of fracture. Why would that be?

The effects of obesity are more complex than that, even if mechanical stress on your bones may strengthen them. Obesity may cause your bones to deteriorate, which can lead to osteoporosis and other bone-related problems. These risks will be covered in more detail below. The microarchitecture (quality) of bone is measured by the Trabecular Bone Score (TBS). Despite having normal bone mass, obese people have been reported to have lower TBS. In reality, research also indicates that children and adults who are overweight or obese have a higher risk of certain fractures and that their bone strength is not related to their body mass.

Let’s now take a closer look at the findings regarding the potential harm that obesity may do to bone health.

How Does Bone Health Get Affected by Obesity?

The link between bone and fat tissue is complicated, much like everything else in the body. Although the exact mechanism underlying the association between fat and osteoporosis has not been determined, a number of factors most likely contribute.

Excess fat tissue and bone have a complicated interaction. There are probably multiple distinct mechanisms underlying the association between obesity and osteoporosis, such as the following:

1 Inflammation

Higher amounts of inflammatory substances that may interact with your body’s various tissues are linked to low-grade, chronic inflammation, which is related with obesity. According to research, because inflammatory substances interact with bone cells, chronic inflammatory diseases of nearly any etiology can result in bone loss.

Research indicates that in an inflammatory setting, osteoblast activity—the cells that form new bone—decreases and osteoclast activity—the cells that tear down existing bone—increases. Consequently, long-term inflammation may cause changes in bone metabolism, which may result in net bone loss.

2 Low Levels of Adiponectin

Adiponectin, a hormone, is another possible cause of the link between fat and osteoporosis. Fat cells, or adipocytes, produce the hormone adiponectin, which is typically reduced in obese people. Adiponectin levels and bone density were considerably lower in postmenopausal women with metabolic syndrome than in healthy controls, according to one study.

How precisely do adiponectin and bone density relate to each other? Researchers discovered in an animal research that mice lacking adiponectin showed symptoms of osteoporosis. Subsequently, scientists discovered that the stem cells in these animals primarily developed into fat cells rather than osteoblast cells, which produce bone.

According to these findings, adiponectin contributes to the development and operation of bone-building cells. The stem cells of obese people may be prepared to produce fat rather than bone because they often have lower levels of adiponectin.

3. Vitamin D Deficiency

The relationship between fat and osteoporosis is probably influenced by hormones and inflammation, although micronutrients also play a part.

Deficits in vitamins and minerals are known to contribute to osteoporosis. Adequate mineralization is essential for strong bones, and nutrients like vitamin D help control these minerals and eventually transport them into your bones.

Sadly, research indicates that there is a negative correlation between body weight and active vitamin D in overweight people. According to study, those who are obese may have 20% lower serum vitamin D concentrations than people who are of a healthy weight.

Your bones cannot absorb the minerals—especially calcium—that they require to become strong and healthy if you don’t get enough vitamin D. Low vitamin D levels can eventually cause osteoporosis by reducing bone density over time.

4. Sedentary Lifestyle – Use it or Lose it!

Because the body consumes more calories than it expends during energy expenditure, more calories are converted and stored as extra fat, which is why a sedentary lifestyle can result in obesity. Additionally, bones that lead sedentary lives do not get the mechanical stimulation necessary to keep them strong. Consequently, bone weakens as a result. Antigravity is another example of this, as astronauts lose their TBS and BMD when in space. Exercises that involve lifting weights and strengthening muscles are crucial for preserving bone mass and averting osteoporosis. The adage “Use it or lose it” applies equally to bone as it does to muscle.

Are osteoporosis and obesity related?

There is currently no proof that osteoporosis is directly caused by fat. The consequences of being overweight on bone health can be both beneficial and detrimental.

It used to be believed that fat mostly protected against osteoporosis. Research had shown that the stronger and denser your bones were, the more weight your skeletal system had to support.

The benefits of weight on the body due to mechanical loading may not be sufficient for other aspects of obesity, according to recent studies.

Not only can obesity increase body weight, but it also has an impact on many biological functions and can result in chronic illnesses that can weaken bones.

What is the relationship between osteoporosis and BMI?

Your weight in kilos divided by your height in meters is your BMI. On a clinical scale, it gives you a ballpark estimate of your body fat percentage.

A low body mass index (BMI) has long been associated with an increased risk of osteoporosis because being underweight can reduce the amount of bone that can be lost.

Your BMI isn’t always a reliable indicator of your body fat. If you have a lot of muscle, it may overstate your body fat, and if you have decreased muscle mass, it may underestimate it.

A 2018 study comparing the percentage of body fat (PBF) and BMI as measures of bone density discovered that PBF was a more reliable indicator of bone health.

What impact does obesity have on bone density?

You have living bones. They are composed of live tissue that changes shape and form during your life due to metabolic activities.

Similar to endocrine organs, bones release hormones. For bones to remain healthy and function properly, several hormones are necessary. Their strength and density may be impacted when the metabolic balance of bones is upset.

Adipose tissue, or bodily fat, secretes its own hormones and other chemicals, according to research. Bone can be indirectly impacted by changes in your body’s biology brought on by excessive body fat.

For instance, the hormone adiponectin is linked to bone growth, glucose management, and anti-inflammatory properties. People who are obese frequently have reduced adiponectin levels.

Specific pro-inflammatory cytokines are elevated when adiponectin levels are low. In the end, this causes your body to undergo a series of reactions that lead to the resorption of bone tissue.

Additional elements

One piece of the obesity-osteoporosis jigsaw is a hormonal imbalance. A 2020 analysis suggests a few other factors that may contribute to obesity, such as:

• Deficiency of vitamin D
• formation of fat in the bone marrow
• An excessively fattening diet
• disorders of metabolism
• consisting of more visceral than superficial abdominal fat

Your body’s microenvironment may be weakened by all of these factors.

Compared to subcutaneous fat, which is fat directly beneath the skin, visceral abdominal fat—such as the deposits of fat around organs and deep within the abdomen—may have a higher metabolic activity.

That means visceral fat might interfere with your body’s functions more than subcutaneous fat.

Osteosarcopenic obesity

A relatively recent word, osteosarcopenic obesity, refers to the co-occurrence of disorders that compromise bone health, such as osteoporosis, and progressive loss of muscle mass and strength, known as sarcopenia.

Not everyone who loses bone due to obesity has osteosarcopenic obesity.

Sarcopenia is a musculoskeletal disorder in which muscular strength, quality, and quantity gradually deteriorates. This condition must also fit the criteria for sarcopenia.

Does an osteoporosis risk factor include a sedentary lifestyle?

The adage “if you don’t use it, you lose it” applies to the risk of osteoporosis.

Your bones react to exercise in the same way as other bodily tissues. Not only can exercise help you achieve your ideal bone mass and strength, but it also lowers your risk of fractures and falls and helps stop bone loss as you age.

An increased risk of osteoporosis is associated with a lower level of physical activity. Your musculoskeletal system—which consists of your bones, muscles, tendons, ligaments, and soft tissue—is less stressed after extended periods of inactivity. There is no reason for your body to build more bone density or strength when there are no pressures on it.

Can eating poorly lead to osteoporosis?

Deficits and imbalances in your diet might also raise your risk of osteoporosis. Bone loss is associated with:

• inadequate calcium
• Deficiency of vitamin D
• Low consumption of protein
• extreme dieting

A high-fat diet may cause systemic inflammation, which raises bone resorption and encourages fat buildup in the bone marrow, according to research.

Does osteoporosis improve with weight loss?

The benefits of weight loss for osteoporosis in obese people have not been thoroughly studied.

Losing weight may help alter metabolic processes that adversely impact bone health, according to some studies. For instance, reducing body fat and losing weight can raise adiponectin levels, which enhance bone mass density.

When you have been diagnosed with osteoporosis, however, you should lose weight gradually and under the supervision of a physician, particularly if you are an older adult.

Rapid weight loss might worsen bone loss by reducing micronutrients like vitamin D and calcium. Your musculoskeletal system may experience bone loss as a result of the abrupt decrease in mechanical stress.

The Management of Obesity and Osteoporosis

It can be challenging to lose weight, particularly if a person has elements that influence their weight (such as certain drugs or medical problems) or has not received the necessary resources and assistance.

Yet, reducing body weight is frequently a crucial part of both managing and treating specific medical issues as well as preventing them.

Lifestyle Changes

It is possible to lose weight safely and effectively by committing to lifestyle modifications that promote a healthier weight. Frequently, these modifications are minor yet nevertheless have an effect. As you want to reduce weight, you can alter your lifestyle in the following ways:

Set small, realistic goals: If you need to drop more than 100 pounds, creating a strategy may seem overwhelming or even unachievable. Nonetheless, setting modest objectives for yourself—like dropping ten pounds at a time—can keep you motivated as you go.

Choose a nutritious diet: According to research, there isn’t a single diet that works best for losing weight. You must choose the appropriate diet for yourself. Low-calorie, low-carb, low-fat, high-fat, high-protein, or Mediterranean diets are among the options, as is intermittent fasting. The best diet is usually the one you will follow.

Exercise more: Exercise of any kind is preferable to none at all. The most effective weight loss exercises burn a lot of calories and are easy to maintain over time, according to research (which will be easier if you pick something you like doing). Weight or strength training, high-intensity interval training, and endurance training are a few types of activities you might wish to attempt.

Safe Exercises

Being physically active on a daily basis can help people with obesity, osteoporosis, or both. However, there are some precautions you should take to ensure that you are exercising properly while experiencing these diseases.

Exercising With Osteoporosis

Maintaining your muscle mass and bone health while you have osteoporosis can be achieved through exercise. However, there are some hazards linked with specific types of exercise that can result in a fracture if your bones are weaker.

If you have osteoporosis, you can safely perform the following exercises, according to the National Osteoporosis Foundation:

• Better posture and a lower chance of fracturing a bone in your spine can be achieved with posture exercises.
• Exercises for strengthening the muscles surrounding your bones are beneficial.
• Exercises that improve balance can help avoid falls.
• Your everyday issues, such being unable to climb stairs, are addressed with functional workouts.

According to the National Osteoporosis Foundation, if you have trouble climbing stairs, you should gradually strengthen your capacity by doing stairs as a simple exercise.

Exercising With Obesity

When exercising, obese people need to exercise with prudence. Start with low-impact activities, like swimming or walking, for instance, to reduce the strain on your joints and body.

You should gradually increase the intensity of your exercise and start out slowly. Exercises that you might want to attempt include the following:

• Water aerobics
• Stationary cycling

Talk to Your Doctor

A new workout regimen should never be started without first consulting your physician. They can assist you in choosing the exercises that will be most advantageous to you and safe.

Medication

Different methods are used by prescription drugs to help people lose weight. You may feel fuller sooner after taking certain drugs, which makes you eat fewer calories. Others prevent the fat from your food from being absorbed by your body.

For those with obesity-related health problems, a prescription drug for weight loss is usually recommended. Contrary to popular belief, exercising and maintaining a nutritious diet are still necessary when using medication to reduce weight. A person must take the drugs in order to lead a better lifestyle.

The following are a few prescription drugs that can aid in weight loss:

• Orlistat: serves to lessen the quantity of fat that is absorbed from diet.
• Phentermine-topiramate: A combo medication that decreases appetite
• Naltrexone-bupropion: A combo medication that promotes rapid feelings of fullness
• Liraglutide: Regulates appetite
• Semaglutide: Regulates appetite
• Setmelanotide: lowers appetite and speeds up metabolism

Surgery

Surgery may be beneficial for those who need to lose weight in order to achieve their objectives. Nevertheless, in order to be eligible for these operations, an individual must be classified as extremely obese based on their body mass index (BMI).

Surgery for weight loss comes in three primary forms:

Adjustable gastric banding: The upper portion of the stomach is banded with saltwater during this procedure. Its purpose is to reduce the size of the stomach, which enables a person to eat less.

Gastric sleeve: The stomach is removed in excess of 50% during this treatment. The area is left with a banana-sized tube or sleeve. Like band surgery, this technique makes the stomach smaller so that less food may be eaten.

Gastric bypass: A portion of the patient’s existing stomach is removed during gastric bypass surgery and attached to the middle section of the small intestine to produce a smaller stomach. The amount of food that the body can digest and assimilate is limited since food is not passed through the remainder of the stomach when a person eats. Consequently, less calories are absorbed as a result.

During weight loss surgery, a big abdominal incision can be made (open) or multiple minor incisions can be performed (laparoscopic). To help the surgeon view within the belly during laparoscopic surgery, cameras are also used.

Natural Treatments

While few natural weight-loss techniques have been scientifically confirmed to work, some have been studied, such as:

Green tea: When paired with a healthy diet and regular exercise, drinking green tea (without any added sugar or milk) can help your body create more energy and possibly burn belly fat.

Probiotics: Gut health can be improved with probiotics, or “good” bacteria. According to studies, eating probiotics may help lower your hunger by preventing the body from absorbing fat from the food you eat.

Mindfulness: The discipline of mindful eating involves practicing awareness and present-moment eating. According to studies, practicing mindfulness during mealtimes can reduce stress eating, increase awareness of hunger cues, and help people choose healthier foods.

Do Natural Remedies Really Work?

The claims that natural treatments can help people lose weight are supported by some scientific evidence, but they should not be viewed as a “cure-all” answer but rather as a supplement to a better lifestyle.

You may lose a little weight by using these natural cures, but you will need to make further adjustments to your habits and lifestyle if you want to lose weight in a long-term and permanent way.

Summary

There are numerous reasons that lead to osteoporosis, and bone loss is a typical aspect of aging to some degree. However, studies have indicated that obese people age more quickly—in fact, obesity may cause aging to accelerate by more than two years.
Being obese may also increase your risk of getting osteoporosis, especially in light of current evidence suggesting that obesity impacts bone health.

You now know that there is evidence linking obesity, osteoporosis, and fracture to hormonal, nutritional, and inflammatory disorders. Maintaining a healthy weight is obviously a crucial step in preserving bone health, even though research in this area is still ongoing.

Conversely, research suggests that underweight may also cause problems for bone density. A body mass index (BMI) below the healthy threshold is linked to weakened bones and a higher risk of fracture.

The remedy? Make every effort to determine a healthy weight for yourself. A nutrient-rich diet can help you obtain the micronutrients required for bone and metabolic health, and include weight-bearing and/or muscle-strengthening exercise in your regimen will improve weight reduction efforts while boosting bone strength.

It used to be believed that obesity and osteoporosis were positively correlated, with the weight of your musculoskeletal system indicating the likelihood of having strong, dense bones.

Even though being overweight still has mechanical advantages, these might not be sufficient to offset the many metabolic problems associated with obesity that might harm bone health.

Bone brittleness and weakening can be indirectly caused by systemic inflammation, visceral and bone marrow fat deposits, and hormone abnormalities associated with obesity.

Even though lowering weight can improve metabolic parameters, removing too much weight too soon can raise your risk of osteoporosis.

You can lower your risk of osteoporosis and obesity by increasing your physical activity and eating a healthy diet. Discuss with your doctor what kind of help you need to reach and stay at the weight that is best for you.

FAQs

Reference

• Gillette, H. (2023, May 19). What’s the relationship between osteoporosis and obesity? Healthline. https://www.healthline.com/health/osteoporosis/osteoporosis-and-obesity
• Bottaro, A. (2024, August 3). Understanding the relationship between obesity and osteoporosis. Verywell Health. https://www.verywellhealth.com/obesity-and-osteoporosis-5206704
• Ziedman, E. (2023, September 6). The relationship between obesity, osteoporosis and fracture. AlgaeCal. https://blog.algaecal.com/obesity-pegs-the-risk-for-developing-osteoporosis/