Childhood obesity, bone development, and cardiometabolic risk factors

• Childhood obesity may be related to suboptimal bone development, as there is mounting evidence linking obesity to fractures.
• Visceral, rather than overall, adiposity may adversely influence bone strength development.
• Obesity-related metabolic impairments, such as insulin resistance and inflammation, may promote suboptimal bone development.

Osteoporosis and obesity are both major public health concerns. It has long been considered that these are distinct disorders rarely found in the same individual; however, emerging evidence supports an important interaction between adipose tissue and the skeleton. Whereas overweight per se may augment bone strength, animal studies suggest that the metabolic impairment that accompanies obesity is detrimental to bone. Obesity during childhood, a critical time for bone development, likely has profound and lasting effects on bone strength and fracture risk. This notion has received little attention in children and results are mixed, with studies reporting that bone strength development is enhanced or impaired by obesity. Whether obesity is a risk factor for osteoporosis or childhood bone health, in general, remains an important clinical question. Here, we will focus on clarifying the controversial relationships between childhood obesity and bone strength development, and provide insights into potential mechanisms that may regulate the effect of excess adiposity on bone.