The Role of Body Composition and Visceral Fat in Osteoporosis Subtype Differentiation: Insights from Bioelectrical Impedance Analysis

Introduction: Osteoporosis is the most prevalent musculoskeletal disease characterized by reduced bone mass, increasing fracture risk. Subtypes include postmenopausal and senile osteoporosis, each with distinct pathophysiological mechanisms. While postmenopausal osteoporosis is driven by estrogen deficiency, senile osteoporosis is associated with chronic inflammation, sarcopenia, and age-related metabolic changes. Recent studies suggest visceral fat may exacerbate inflammatory processes, contributing to bone loss. However, differences in body composition and cytokine profiles across osteoporosis subtypes remain underexplored. This study explores the impact of body composition (BC), particularly visceral fat, on osteoporosis subtypes and analyzes cytokine profiles to elucidate inflammatory contributions.

Methods: This prospective study included 49 women aged 60 and older, who underwent treatment for a osteoporotic fractures of the hip or pelvis or coxarthrosis. They were divided into senile (n=20), postmenopausal (n=12), and control (n=15) groups. All participants underwent detailed clinical evaluation, laboratory diagnostics, and Body impedance analysis (BIA) to assess BC parameters, including muscle mass (MM), fat mass (FM) and visceral adipose tissue (VAT), Serum cytokine levels (IL-6, and CCL-2) were measured perioperatively in a second cohort of 103 patients to evaluate inflammatory burden.

Results: Significant differences in body composition were observed across groups. Senile and postmenopausal osteoporosis patients exhibited the lowest MM (22.5 and 24.5 kg) compared to controls (27.7 kg; p<0.05). While VAT was not significantly different in absolute terms, the VAT/FM ratio was higher in the senile group (6.7) than in controls (4.2; p<0.05), indicating a relative increase in visceral fat. Postmenopausal patients demonstrated intermediate values (4.6, p=0.06 compared to controls) with similar trends.Inflammatory cytokine analysis revealed elevated IL-6 levels in both osteoporosis groups compared to controls (senile: 55 U/L; postmenopausal: 31 U/L; controls: 10.3 U/L; p<0.05). Interestingly, postmenopausal patients exhibited persistently high CCL-2 (176.9 U/L) levels postoperatively, surpassing senile and control groups (p<0.05).

Discussion: This study highlights the distinct body composition and inflammatory profiles of senile and postmenopausal osteoporosis patients. Both groups exhibit increased relative VAT, consistent with elevated inflammatory cytokine levels. The study highlights the relevance of BIA measurement in the diagnosis and subtype differentiation of osteoporosis, emphasizing the potential role of visceral fat in the chronic inflammatory pathogenesis of osteoporosis. Future studies should investigate the potential use of visceral fat in the early detection and differentiation of osteoporosis in larger patient cohorts.

Keywords: osteoporosis, body impedance analysis, visceral fat, inflammation

Korrespondenzadresse: Christoph Beyersdorf, Universitätsklinikum Düsseldorf, Klinik für Orthopädie und Unfallchirurgie, Moorenstraße 5, 40225 Düsseldorf, Deutschland, E-Mail: [e-mail]

Publication History

Article published online:
21 March 2025