title: Increasing adiposity is associated with higher adipokine levels and lower bone mineral density in obese older adults.
abstract: BACKGROUND
  Although obesity is associated with high bone mass, recent reports suggest an increase in the incidence of fractures in obese patients.
  
  
  OBJECTIVE
  The objectives of the study were to evaluate the influence of increasing body fat on bone mineral density (BMD) and to determine the influence of the different adipokines on BMD in frail obese elderly patients.
  
  
  METHODS
  This is a cross-sectional study of baseline characteristics of elderly obese patients participating in a lifestyle therapy with diet with or without exercise and conducted in a university setting.
  
  
  METHODS
  One hundred seventy-three, elderly (≥65 y old), obese (body mass index of ≥30 kg/m(2)) who were mostly frail participated in the study.
  
  
  METHODS
  BMD, percentage of total body fat, percentage of fat-free mass, percentage of lean mass, body mass index, adiponectin, leptin, IL-6, bone turnover markers (osteocalcin and C-telopeptide), high-sensitivity C-reactive protein, free estradiol, and 25-hydroxyvitamin D were measured.
  
  
  RESULTS
  Higher tertiles of percentage body fat and lower lean mass were associated with a lower BMD. High-sensitivity C-reactive protein levels were highest in the highest fat tertile (third, 5.5 ± 5.4 vs first, 1.5 ± 1.3 mg/L, P < .05) for women, whereas IL-6 levels were highest in the highest tertile in men (third, 3.5 ± 3.1 vs first, 1.7 ± 0.8 pg/mL, P < .05). Leptin increased with increasing fat tertiles in both genders (P < .05), whereas adiponectin increased with increasing fat tertiles only in men (P < .05). A multivariate analysis revealed adiponectin as an important mediator of the effect of fat mass on BMD. Osteocalcin levels were highest in the highest fat tertile in women but not in men. Physical function test scores decreased with increasing fat tertiles in women (P < .05) but not in men.
  
  
  CONCLUSIONS
  Increasing adiposity together with decreasing lean mass is associated with lower BMD, higher adipokine levels, and worsening frailty in elderly obese adults.
authors.affiliation: Medicine and Research Services (L.A., D.W., C.Q., D.T.V., R.A.-V.), New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; Biomedical Research Institute of New Mexico (L.A., C.Q.), Albuquerque, New Mexico 87108; Department of Medicine (N.N., D.T.V.), Washington University School of Medicine, St Louis, Missouri 63110; Department of Medicine (N.N.), Campus Biomedico, 00128 Rome, Italy; Departments of Medicine, Mathematics, and Statistics (C.Q., D.T.V., R.A.-V.), University of New Mexico, Albuquerque, New Mexico 87131; and Department of Preventive and Social Medicine (D.W.), University of Otago, Dunedin 9054, New Zealand.
authors.forename: Lina
authors.initials: L
authors.lastname: Aguirre
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
authors.forename: Debra
authors.initials: D
authors.lastname: Waters
authors.forename: Clifford
authors.initials: C
authors.lastname: Qualls
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Villareal
authors.forename: Reina
authors.initials: R
authors.lastname: Armamento-Villareal
mesh_terms: D052242:Adiponectin / Q000097:blood*; D050154:Adiposity / Q000502:physiology*; D000368:Aged; D000375:Aging / Q000378:metabolism*; D001823:Body Composition; D015992:Body Mass Index; D015519:Bone Density / Q000502:physiology*; D002097:C-Reactive Protein / Q000378:metabolism; D003430:Cross-Sectional Studies; D015444:Exercise; D005260:Female; D016330:Frail Elderly; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood*; D008297:Male; D009765:Obesity / Q000378:metabolism*; D015675:Osteocalcin / Q000097:blood; D057185:Sedentary Behavior
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; C508600:IL6 protein, human; D015850:Interleukin-6; D020738:Leptin; D015675:Osteocalcin; D002097:C-Reactive Protein