IBMS BoneKEy | Perspective
Osteoporosis as a lipotoxic disease
The skeletal system, and adipose tissue, are two body systems that have seen major paradigm shifts in the understanding of their biology in recent years. Going beyond their respective traditional functions of locomotion and energy storage, a complex relationship between the two systems is being unraveled. In this review, we start first by describing current knowledge on the “systemic” interaction between fat and bone. However, the local interaction within the bone marrow milieu seems to play a more important role in the pathogenesis of osteoporosis. Increasing levels of mesenchymal stem cell differentiation into fat may have a lipotoxic effect on osteoblast function and survival while simultaneously stimulating osteoclastic activity. The end result will be increasing levels of bone resorption and decreasing levels of bone formation, the typical features of osteoporosis. Finally, the potential diagnostic and therapeutic implications of marrow fat infiltration will be discussed.
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