Visceral Adipose Tissue is Negatively Associated With Bone Mineral Density in NHANES 2011-2018

CONTEXT: The relationship of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) with bone mineral density (BMD) is not well established. OBJECTIVE: To examine the associations of VAT and SAT with total body BMD in a large, nationally representative population with a wide range of adiposity. METHODS: We analyzed 10 641 subjects aged 20 to 59 years in National Health and Nutrition Examination Survey 2011-2018 who had undergone total body BMD and had VAT and SAT measured by dual-energy X-ray absorptiometry. Linear regression models were fitted while controlling for age, sex, race or ethnicity, smoking status, height, and lean mass index. RESULTS: In a fully adjusted model, each higher quartile of VAT was associated with an average of 0.22 lower T-score (95% CI, −0.26 to −0.17, P < 0.001), whereas SAT had a weak association with BMD but only in men (−0.10; 95% CI, −0.17 to −0.04, P = 0.002). However, the association of SAT to BMD in men was no longer significant after controlling for bioavailable sex hormones. In subgroup analysis, we also found differences in the relationship of VAT to BMD in Black and Asian subjects, but these differences were eliminated after accounting for racial and ethnic differences in VAT norms. CONCLUSIONS: VAT has a negative association with BMD. Further research is needed to better understand the mechanism of action and, more generally, to develop strategies for optimizing bone health in obese subjects.