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Healthy bones are dense and strong, helping protect you from fractures during a fall or accident. But when bones become brittle — a condition known as osteoporosis — they can break easily, even from minor bumps or slips. Obesity may increase the risk of bone health problems, including osteoporosis.
“I was just diagnosed with extreme osteoporosis,” a MyObesityTeam member said. “I’m afraid to do anything.”
Osteoporosis doesn’t usually cause symptoms until you break a bone. However, early signs can include changes in posture or a loss of height. Some people may also experience lower back pain, a symptom that’s also common among people with obesity.
In this article, we’ll explore how obesity may affect bone health and what steps you can take to help prevent osteoporosis.
Osteoporosis is a condition that makes bones weaker and more likely to break. Many people discover they have it only after a surprise fracture. So, how does osteoporosis develop?
Everyone’s bones become a little more fragile as they age. This is because the body slows down its process of building new bone.
But osteoporosis goes beyond normal aging. In healthy bones, cells break down and rebuild continuously. If you have osteoporosis, your body loses bone cells faster than it can replace them. Over time, this imbalance leads to brittle bones that are more prone to fractures.
Several factors can increase your risk of developing osteoporosis:
In the past, researchers believed a higher body weight helped protect against osteoporosis. Some studies still suggest that people living with obesity have a higher bone density (BMD). BMD refers to the amount of minerals (like calcium) in your bones — a measure of how strong your bones are.
However, newer research paints a more complex picture. One study found that certain traits linked to obesity — such as inflammation and increased fat in bone marrow — may affect the bone remodeling process. Bone remodeling is how your body removes old bone tissue and replaces it with new tissue. When this balance is disrupted, bone quality may decline, even if bone density appears high.
Doctors often use a tool called body mass index (BMI) to help estimate whether a person is underweight, has a “normal” weight, is overweight, or lives with obesity. BMI is calculated by dividing a person’s weight in kilograms by the square of their height in meters.
Although BMI doesn’t directly measure body fat or health, it’s a quick screening tool that can help identify risks, including those related to bone health.
The categories are:
It’s important to remember that BMI is just one piece of the puzzle. Factors like muscle mass, body composition, age, and health history all matter when it comes to bone strength and overall health.
People with a high body mass index often have higher BMD. At first glance, this may sound beneficial for bone health. But the relationship between obesity and osteoporosis isn’t so simple.
Carrying more body weight usually puts more pressure on bones, which can help keep them strong, similar to how strength training can increase BMD. But weight from excess fat doesn’t always have the same effect as lifting weights. That’s because obesity involves complex changes in hormones, inflammation, and metabolism that may actually weaken bones over time.
Studies show that children and teens living with obesity are more likely to experience bone problems than adults. The research about obesity and bone density still has mixed findings. More studies are needed to explain how body weight and bone tissue affect each other at different life stages.
People who have a low BMI or are underweight have a lower BMD. This increases the risk of developing osteoporosis and makes bones more likely to break.
People living with obesity tend to have higher BMD, but that doesn’t always mean their bones are healthier. Obesity changes how the body functions, including how bones grow and break down.
Fat and bone communicate in several ways, and excess body fat may affect this system. Here are some of the reasons why.
Fat tissue (also called adipose tissue) isn’t just for energy storage. Some health experts now consider it part of the endocrine system, because it releases chemical messengers called adipokines, including leptin, that affect many parts of the body.
Estrogen is a hormone that helps protect bone health by slowing down bone breakdown and supporting the production of new bone cells in the marrow. After menopause, estrogen levels drop, raising the risk of osteoporosis. Both reproductive organs and fat tissue produce estrogen, which may partly explain why people living with obesity often have higher BMD.
Leptin, another hormone from adipose tissue, helps control hunger and energy use. People living with obesity tend to have higher leptin levels. However, they may also develop leptin resistance, meaning their body doesn’t respond to leptin properly.
Health experts are still studying leptin’s role in bone health. Some studies suggest that high leptin levels may boost the growth of osteoblasts (cells that build bone) and reduce osteoclasts (cells that break down bone tissue). This could lead to higher BMD. But other studies suggest that leptin resistance may lower BMD. More studies are needed to understand these mixed results.
Obesity is linked to low-grade chronic inflammation throughout the body, which may harm bones over time and increase the risk of osteoporosis.
Scientists aren’t sure what causes fat to accumulate in bone marrow, but it appears to be common with age. Recent studies have shown that people with osteoporosis often have high levels of fat in their bone marrow. This might slow the production of bone tissue.
Several health conditions and lifestyle factors linked to obesity can also increase the risk of developing osteoporosis.
Type 2 diabetes is a risk factor for osteoporosis because of the way it affects the hormone insulin. Insulin, which comes from your pancreas, regulates your blood glucose (sugar). It also controls your energy levels, much like leptin. People with type 2 diabetes have insulin resistance (trouble using insulin), which may contribute to osteoporosis. Obesity is a risk factor for type 2 diabetes and insulin resistance.
When you don’t move much, your bones don’t get the stimulation they need to stay strong. Weight-bearing and resistance exercises are among the most effective ways to maintain or improve bone density. A lack of regular physical activity can lead to lower BMD and a higher chance of fractures.
Between 40 percent and 80 percent of people living with obesity have low vitamin D levels. Vitamin D helps your body absorb calcium — a key building block of bone — and supports muscle function, which can help prevent falls. Low vitamin D is a known risk factor for osteoporosis.
Talk to your doctor about whether you’re getting enough calcium and vitamin D. They may recommend supplements or testing your levels. If they do suggest supplements, ask for recommendations about choosing a reputable brand.
Sarcopenic obesity is a type of obesity that involves high body fat and low muscle mass. People with sarcopenic obesity have lower BMD than those with the same BMI without sarcopenia (loss of muscle).
Individuals living with sarcopenic obesity tend to have weaker muscles and poor muscle function. This may put them at risk for osteoporosis-related falls and broken bones. If you’re unsure about your body composition, ask your doctor whether testing for sarcopenia might be helpful.
Some obesity treatments can affect your bone density and put you at a higher risk for osteoporosis.
One MyObesityTeam member said they were taking topiramate, which impacted their bone health. “I take it for weight loss, and I have two herniated discs and a sciatic nerve problem with a chipped bone,” they said.
The drug combination of phentermine and topiramate is often prescribed for weight loss because it reduces appetite. Topiramate and similar medications can reduce your bone density.
Other medications for obesity, including glucagon-like peptide-1 receptor agonists (GLP-1 agonists) such as semaglutide and liraglutide, may have the opposite effect. Early studies suggest they help with bone formation and stop bone loss.
Talk to your doctor about your obesity medications and how they may affect your bone health.
Having bariatric (weight loss) surgery is a risk factor for osteoporosis. Your BMD decreases significantly in the years after a weight loss surgery. This happens because the surgery can affect your hormones and your ability to absorb calcium.
Rapid major weight loss of any kind can affect your BMD. It’s important to exercise and work with your doctor to build muscle while losing weight.
Talk to your doctor about protecting your bone health while living with obesity or being treated for it. Your doctor or dietitian can share helpful tips for supporting your bone health to prevent osteoporosis. This may include performing weight-bearing exercises or getting more calcium and vitamin D.
If you have osteoporosis, getting the nutrients you need and exercising regularly can help you avoid falling and fractures. Your doctor might also prescribe hormones or medications to support your bone density.
On MyObesityTeam, the social network for people with obesity and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with obesity.
Do you have osteoporosis and obesity? How do you support your bone health? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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