OBESITY AND SKELETAL FRAGILITY IN AGING POPULATIONS: REVISITING THE OBESITY-OSTEOPOROSIS PARADOX

Tóm tắt

Introduction: Obesity and osteoporosis are increasingly coexisting conditions in aging populations. Traditionally, obesity has been viewed as protective against osteoporosis, given that a higher body mass index (BMI) is linked to increased bone mineral density (BMD). However, emerging evidence calls this assumption into question, suggesting that excess adiposity may negatively impact skeletal health, even in the presence of elevated BMD. Methods: This narrative review synthesizes current evidence regarding the relationship between obesity and skeletal health in middle-aged and older adults. Relevant literature was identified through structured searches in PubMed, Scopus, and Web of Science, focusing on studies evaluating obesity, body composition, bone mineral density, fracture risk, and sarcopenic obesity. Results: Although obesity is generally associated with higher BMD, accumulating epidemiological evidence indicates that fracture risk in obese individuals is heterogeneous and often site-specific. Visceral adiposity, chronic low-grade inflammation, and bone marrow adiposity may impair bone microarchitecture and bone quality despite preserved bone density. In addition, sarcopenic obesity, characterized by excess fat mass combined with reduced muscle mass, has emerged as an important contributor to skeletal fragility through increased fall risk and impaired functional mobility. Discussion and Conclusion: These findings highlight a complex interaction between adipose tissue, muscle, and bone metabolism. Reliance on BMI or BMD alone may therefore underestimate fracture risk in obese individuals. Obesity should not be considered uniformly protective against skeletal fragility in aging populations. A comprehensive evaluation of body composition, bone quality, and functional status is essential for accurate fracture risk assessment in aging populations.