The Impact of Fat and Obesity on Bone Microarchitecture and Strength in Children
The Impact of Fat and Obesity on Bone Microarchitecture and Strength in Children
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DOI：
10.1007/s00223-016-0218-3
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发表时间：
2017-05-01
影响因子：
4.2
通讯作者：
Dimitri, Paul
中科院分区：
文献类型：
--
作者：
Farr, Joshua N.;Dimitri, Paul
遗传、环境、激素和行为因素的复杂相互作用影响骨骼发育，其中一些与儿童骨折有关。鉴于世界范围内肥胖人数的增加，儿童时期过多的脂肪堆积似乎是骨折的一个危险因素，这一点尤其值得关注。对于这种较高的骨折风险，合理的解释包括：更容易摔倒、摔倒后产生更大的力量、不健康的生活习惯，以及可能对骨骼发育产生直接或间接有害影响的过多脂肪组织。迄今为止，关于肥胖和肥胖对骨骼发育的影响以及支撑这些变化的机制仍然没有定论或共识。成像方式的局限性，纵向研究的随访时间短，以及所检查的队列之间的差异都可能导致相互矛盾的结果。尽管如此，肥胖增加和骨骼发育之间的线性关系似乎不太可能。如果脂肪量的增加不过度，脂肪量可能对正在发育的皮质和骨小梁间室有利。然而，当脂肪堆积达到过量水平时，不利的代谢变化可能会阻碍骨骼发育。支持这些变化的机制可能与激素环境的变化有关，脂肪因子可能起着核心作用，但研究结果再次令人困惑。脂肪和骨骼之间关系的变化似乎也与年龄和性别有关。显然，需要做更多的工作来更好地理解脂肪和肥胖对儿童时期骨骼发育和骨折风险的有争议的影响。
A complex interplay of genetic, environmental, hormonal, and behavioral factors affect skeletal development, several of which are associated with childhood fractures. Given the rise in obesity worldwide, it is of particular concern that excess fat accumulation during childhood appears to be a risk factor for fractures. Plausible explanations for this higher fracture risk include a greater propensity for falls, greater force generation upon fall impact, unhealthy lifestyle habits, and excessive adipose tissue that may have direct or indirect detrimental effects on skeletal development. To date, there remains little resolution or agreement about the impact of obesity and adiposity on skeletal development as well as the mechanisms underpinning these changes. Limitations of imaging modalities, short duration of follow-up in longitudinal studies, and differences among cohorts examined may all contribute to conflicting results. Nonetheless, a linear relationship between increasing adiposity and skeletal development seems unlikely. Fat mass may confer advantages to the developing cortical and trabecular bone compartments, provided that gains in fat mass are not excessive. However, when fat mass accumulation reaches excessive levels, unfavorable metabolic changes may impede skeletal development. Mechanisms underpinning these changes may relate to changes in the hormonal milieu, with adipokines potentially playing a central role, but again findings have been confounding. Changes in the relationship between fat and bone also appear to be age and sex dependent. Clearly, more work is needed to better understand the controversial impact of fat and obesity on skeletal development and fracture risk during childhood.