中国骨质疏松杂志

肥胖和脂质代谢与骨质疏松关系

Relationship between obesity, lipid metabolismand osteoporosis

DOI：10.3969/j.issn.1006-7108.2025.09.017

基金项目:国家自然科学基金（82174414；82274543）；国家中医药管理局全国名老中医药专家传承工作室建设项目[国中医药人教函(2022)75号]；湖南省中医药管理局“十四五”第一批中医药领军人才培养项目（rsk-023-01）

作者	单位
叶子丰1,2 院一蔚1 邱礼国1,2 谭旭仪3 邝高艳2 卢敏2	1.湖南中医药大学，湖南长沙 410208 2.湖南中医药大学第一附属医院，湖南长沙 410007 3.湖南省中医药研究院附属医院，湖南长沙 410006

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中文摘要:

骨质疏松症是一种常见的骨代谢性疾病。在治疗中，提高成骨能力是纠正骨量损失的必要条件。脂质与骨代谢的关系近年来越来越受到关注。成骨细胞、脂肪细胞均来源于骨髓间充质干细胞的分化，研究表明脂肪细胞的增加伴随着骨密度（bone mineral density，BMD）和骨量的下降。脂质含量和比例可通过调节免疫细胞（主要是巨噬细胞）的活性与IL-1、IL-6、TNF-α等炎性因子的释放增加破骨细胞活性，促进破骨细胞的分化，导致骨失衡和骨吸收增强。同时肥胖还会降低抗氧化酶的活性，导致氧化应激，从而抑制成骨。本文从骨髓间充质干细胞的双向分化入手，详细阐述了脂肪细胞和成骨细胞分化过程及脂质影响骨代谢的机制，并讨论炎症、氧化应激在这一过程中的调节作用。因此，合理调整脂质含量和比例，减轻脂质失衡引起的炎症释放和氧化损伤，将改善骨量，有效防治骨质疏松症。

英文摘要:

Osteoporosis is a common bone metabolism disease. In treatment, enhancing osteogenic capacity is a necessary condition for correcting bone mass loss. The relationship between lipids and bone metabolism has garnered increasing attention in recent years. Both osteoblasts and adipocytes originate from the differentiation of bone marrow mesenchymal stem cells, and studies have shown that an increase in adipocytes is associated with a decrease in bone mineral density (BMD) and bone mass. The lipid content and ratio can increase osteoclast activity by modulating the activity of immune cells (primarily macrophages) and the release of inflammatory factors such as IL-1, IL-6, and TNF-α, promoting osteoclast differentiation, which leads to bone imbalance and enhanced bone resorption. Additionally, obesity can reduce the activity of antioxidant enzymes, resulting in oxidative stress that inhibits osteogenesis. This article begins with the bidirectional differentiation of bone marrow mesenchymal stem cells, elaborating on the differentiation processes of adipocytes and osteoblasts, as well as the mechanisms by which lipids influence bone metabolism. It also discusses the regulatory roles of inflammation and oxidative stress in this process. In summary, appropriately adjusting lipid content and ratios, and mitigating inflammation and oxidative damage caused by lipid imbalance will improve bone mass and effectively prevent and treat osteoporosis.

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