肥胖与骨质疏松症关系的研究进展  

Advances in the relationship between obesity and osteoporosis

作　　者：鲍晓雪 王娜[1] 李玉坤[1] 

机构地区：[1]河北医科大学第三医院内分泌二科河北省骨科生物力学重点实验室,石家庄050051

出　　处：《中华临床医师杂志（电子版）》2015年第14期115-119,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：河北省医学适用技术跟踪项目(GL2014044)

摘　　要：肥胖是许多慢性疾病的危险因素。肥胖与骨之间的病理生理关系是复杂的,最近来自流行病学和动物研究的数据表明:脂肪堆积对骨密度不利。肥胖可能通过多种机制影响骨代谢,由于脂肪细胞和成骨细胞起源于共同的多能间充质干细胞,肥胖能增强脂肪细胞分化并促进脂肪积累,进而减少成骨细胞分化和骨形成。肥胖与慢性炎症有关,在肥胖患者中,循环血液和组织的促炎细胞因子水平增加,从而通过修饰NF-κB(RANK)/RANKL/骨保护通路的受体活性,而增进破骨细胞活性并加速骨吸收。此外,肥胖患者中脂肪细胞分泌瘦素过多和(或)脂联素生成过少可能直接影响骨形成或通过上调促炎细胞因子而间接影响骨吸收。另外,高脂摄入可能干预肠道钙吸收而降低成骨可利用的钙量。本篇叙述了肥胖对骨代谢影响的作用机制,阐明脂肪和骨代谢之间在分子水平的关系,有助于开发预防或治疗肥胖和骨质疏松的治疗性药剂。Obesity is traditionally viewed to be a risk factor for many other chronic health disorders. The underline pathophysiological relationship between obesity and bone is complex. Recent data from epidemiological and animal studies strongly support that fat accumulation is detrimental to bone mass. Because both adipocytes and osteoblasts are derived from a common multipotential mesenchymal stem cell, obesity may increase adipocyte differentiation and fat accumulation while decrease osteoblast differentiation and bone formation. Obesity is associated with chronic inflammation. The increased circulating and tissue proinflammatory cytokines in obesity may promote osteoclast activity and bone resorption through modifying the receptor activator of NF-kB （RANK）/RANK ligand/osteoprotegerin pathway. Furthermore, the excessive secretion of leptin and/or decreased production of adiponectin by adipocytes in obesity may either directly affect bone formation or indirectly affect bone resorption through up-regulated proinflammatory cytokine production. Finally, high-fat intake may interfere with intestinal calcium absorption and therefore decrease calcium availability for bone formation. This review described the mechanism of the effect of obesity on bone metabolism. Unraveling the relationship between fat and bone metabolism at molecular level may help us to develop therapeutic agents to prevent or treat both obesity and osteoporosis.

关 键 词：肥胖症 骨质疏松 脂肪因子类 促炎细胞因子 

分 类 号：R589.2[医药卫生—内分泌] R580[医药卫生—内科学]