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Parathyroid Disorders and Treatments · Journal article
Endocrinology and Metabolism · August 6, 2026
Encouraging direction, but not yet definitive.
In this cross-sectional study of 254 participants, insulin resistance independently predicted lower trabecular bone score (TBS) in obese individuals despite preserved bone mineral density, suggesting metabolic dysfunction rather than mechanical loading drives bone fragility in obesity. TBS detected bone quality impairment that BMD alone did not capture, though the association was attenuated when adjusted for glycaemic control.
Retrospective cross-sectional study. 153 individuals with severe obesity undergoing bariatric metabolic surgery and 101 age- and sex-matched non-obese controls.. Compared with: Non-obese controls matched by age and sex.. n = 254.
BMD significantly higher in obese group, but spine-hip Z-score discordance proportions significantly higher (P=0.001) TBS at L1 significantly higher in obese group (P=0.002); partially degraded or degraded TBS higher in obese group (P=0.021) Among obese participants, TBS decreased progressively across HOMA-IR quartiles (P=0.043) while BMD remained stable
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Clinicians assessing skeletal health in obese patients should consider TBS alongside or instead of BMD alone, as metabolic dysfunction (insulin resistance) may compromise bone quality despite preserved bone density. This suggests screening for and managing insulin resistance could be relevant to fracture risk reduction in obesity.
Cross-sectional study with adequate sample size demonstrating independent association between insulin resistance and trabecular bone quality (not density) in obesity; mechanistic insight but no intervention or longitudinal outcome data.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians assessing skeletal health in obese patients should consider TBS alongside or instead of BMD alone, as metabolic dysfunction (insulin resistance) may compromise bone quality despite preserved bone density. This suggests screening for and managing insulin resistance could be relevant to fracture risk reduction in obesity.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background: Obesity has been considered protective against osteoporosis due to its association with higher bone mineral density (BMD). However, metabolic dysfunction, particularly insulin resistance (IR), may compromise bone quality even with BMD preserved. Methods: This retrospective cross-sectional study (n=254) included 153 individuals with severe obesity undergoing bariatric metabolic surgery and 101 age- and sex-matched non-obese controls. BMD and trabecular bone score (TBS) were measured using dualenergy X-ray absorptiometry. A subgroup of participants with obesity was further analyzed to examine associations between IR, assessed using the homeostasis model assessment of insulin resistance (HOMA-IR), and bone parameters. Results: BMD was significantly higher in the obese group, indicating preserved bone mass in obesity. But the proportions of spine-hip Z-score discordance was significant higher in the obese group (P=0.001). TBS displayed sitespecific findings: TBS at L1 was significantly higher in the obese group (P=0.002), whereas no significant differences were observed at L2-L4. Partially degraded or degraded TBS were higher in the obese group (P=0.021). Among participants with obesity, TBS decreased progressively across HOMA-IR quartiles (P=0.043), whereas BMD remained stable. In multivariable regression, higher HOMA-IR was independently associated with lower TBS (β=-0.0025; 95% confidence interval, -0.0043 to -0.0006; P=0.015), although this association was attenuated by hemoglobin A1c adjustment. Conclusion: Patients with obesity demonstrated site-specific reductions in trabecular bone quality, particularly in the lower lumbar spine compared with non-obese people. IR was independently and inversely associated with TBS, suggesting that metabolic dysfunction, not mechanical loading, influences bone fragility in obesity. TBS represents a valuable adjunct to BMD for assessing skeletal health in metabolically impaired obese populations.
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