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Fat targets for skeletal health

Nature Reviews Rheumatology volume 5, pages 365–372 (2009)Cite this article

Abstract

Emerging evidence points to a critical role for the skeleton in several homeostatic processes, including energy balance. The connection between fuel utilization and skeletal remodeling begins in the bone marrow with lineage allocation of mesenchymal stem cells to adipocytes or osteoblasts. Mature bone cells secrete factors that influence insulin sensitivity, and fat cells synthesize cytokines that regulate osteoblast differentiation; thus, these two pathways are closely linked. The emerging importance of the bone–fat interaction suggests that novel molecules could be used as targets to enhance bone formation and possibly prevent fractures. In this article, we discuss three pathways that could be pharmacologically targeted for the ultimate goal of enhancing bone mass and reducing osteoporotic fracture risk: the leptin, peroxisome proliferator-activated receptor gamma and osteocalcin pathways. Not surprisingly, because of the complex interactions across homeostatic networks, other pathways will probably be activated by this targeting, which could prove to be beneficial or detrimental for the organism. Hence, a more complete picture of energy utilization and skeletal remodeling will be required to bring any potential agents into the future clinical armamentarium.

Key Points

  • Bone and fat arise from the same mesenchymal stem cells in the bone marrow

  • Osteoblasts secrete factors that regulate insulin production and adipocyte sensitivity to insulin

  • Leptin is an adipokine that acts through the hypothalamus to regulate appetite and bone remodeling

  • Peripheral fat stores are hormonally active and might regulate bone turnover

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Figure 1: PPARγ regulates bone mass in the bone marrow milieu.
Figure 2: Central and peripheral leptin signaling.
Figure 3: The three distinct networks that link bone and fat.

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Acknowledgements

This work was supported by NIH NIAMS grants AR 45433, 54604 to C. J. Rosen.

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  1. Maine Medical Center Research Institute, Scarborough, ME, USA

    Masanobu Kawai & Clifford J. Rosen

  2. Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, MA, USA

    Maureen J. Devlin

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Kawai, M., Devlin, M. & Rosen, C. Fat targets for skeletal health. Nat Rev Rheumatol 5, 365–372 (2009). https://doi.org/10.1038/nrrheum.2009.102

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