{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T21:41:59Z","timestamp":1773265319541,"version":"3.50.1"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prevalence of osteoporosis is steadily increasing. Although the relationships between muscle mass, fat mass, and bone mineral content (BMC) have been extensively studied, they remain contentious. This study aimed to develop a unified statistical model to evaluate the independent effects of total muscle and fat mass on BMC, clarify their respective roles in osteoporosis pathogenesis, and inform targeted prevention strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed data from 628 subjects who underwent body composition assessment at the Affiliated Hospital of Nanjing University of Chinese Medicine between January 2022 and July 2024. Collected parameters included age, height, weight, body mass index (BMI), total BMC, total muscle mass, total fat mass, and whole-body bone mineral density (BMD) T-scores. Groups were compared by sex, age and whole-body BMD T-score categories. Spearman correlation and multiple linear regression analyses were used to assess the associations of total BMC with total muscle and total fat mass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Males had greater height, weight, BMI, total BMC, total muscle mass, and whole-body T-scores than females (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001), while females had higher total fat mass. Total muscle mass consistently showed a stronger positive correlation with total BMC than total fat mass across all subgroups. Multiple linear regression analysis confirmed total muscle mass was the strongest and stable independent positive correlate of total BMC(overall sample\n                      <jats:italic>\u03b2=<\/jats:italic>\n                      0.687,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). Total fat mass was positively associated with total BMC only in females, individuals &amp;gt;70 years, and osteoporosis patients, not in normal\/osteopenic groups. Age negatively correlated with total BMC, especially in females (\n                      <jats:italic>\u03b2=<\/jats:italic>\n                      -0.395,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). BMI correlated with lower total BMC in the total sample, females, and osteopenia group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Muscle mass is the strongest and most consistent correlate of BMC. The role of fat is context-specific, varying by sex, age, and bone health. Based on current associative evidence, maintaining muscle may be considered a priority in bone health management, while fat\u2019s impact requires individualized assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>http:\/\/www.chictr.org.cn\/<\/jats:ext-link>\n                      identifier ChiCTR2400085209.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1798429","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:36:49Z","timestamp":1773207409000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of the effects of whole-body muscle and fat mass on bone mineral content based on 628 DXA datasets"],"prefix":"10.3389","volume":"17","author":[{"given":"Jing","family":"Liu","sequence":"first","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dongpan","family":"Chen","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tanli","family":"Min","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Bai","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng","family":"Wang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zun","family":"Wang","sequence":"additional","affiliation":[{"name":"School of Acupuncture-Moxibustion and Tuina, Nanjing University of Chinese Medicine","place":["Nanjing, China"]},{"name":"School of Health Preservation and Rehabilitation, Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mai","family":"Chen","sequence":"additional","affiliation":[{"name":"Zhimaying Community Health Center","place":["Qinhuai, Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biyun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daoming","family":"Xu","sequence":"additional","affiliation":[{"name":"Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1001\/jama.2025.6003(2025","article-title":"Osteoporosis: A review","volume":"334","author":"Morin","year":"2025","journal-title":"JAMA"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41574-025-01088-x(2025","article-title":"Bone and muscle crosstalk in ageing and disease","volume":"21","author":"Kirk","year":"2025","journal-title":"Nat Rev Endocrinol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"573","DOI":"10.3969\/j.issn.1674-2591.2022.06.001(2022","article-title":"Primary osteoporosis guideline for diagnosis and treatment (2022)","volume":"5","year":"2022","journal-title":"Chin J Osteoporos Bone Miner Res"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/3548284(2019","article-title":"Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DXA): A critical overview","volume":"2019","author":"Marra","year":"2019","journal-title":"Contrast Media Mol Img"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-016-0589-3(2016","article-title":"The role of DXA in sarcopenia","volume":"28","author":"Guglielmi","year":"2016","journal-title":"Aging Clin Exp Res"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.mam.2025.101367(2025","article-title":"The bone-muscle unit: from mechanical coupling to soluble factors-mediated signaling","volume":"103","author":"Malvandi","year":"2025","journal-title":"Mol Aspects Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"886","DOI":"10.1038\/s41580-024-00773-5(2024","article-title":"Mechanisms of mechanotransduction and physiological roles of PIEZO channels","volume":"25","author":"Xiao","year":"2024","journal-title":"Nat Rev Mol Cell Biol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.16156\/j.1004-7220.2024.02.003(2024","article-title":"Mechanosensors in osteocytes","volume":"39","author":"Liu","year":"2024","journal-title":"JournalofMedicalBiomechanics"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jare.2023.09.001(2024","article-title":"Irisin as an agent for protecting against osteoporosis: A review of the current mechanisms and pathways","volume":"62","author":"Hu","year":"2024","journal-title":"J Adv Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1287972(2024","article-title":"Mechanism and physical activities in bone-skeletal muscle crosstalk","volume":"14","author":"Zhao","year":"2024","journal-title":"Front Endocrinol (Laus)"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3390\/biom15060893(2025","article-title":"Exercise-mediated skeletal muscle-derived IL-6 regulates bone metabolism: A new perspective on muscle-bone crosstalk","volume":"15","author":"Zhu","year":"2025","journal-title":"Biomolecules"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1016\/j.cmet.2023.10.013(2023","article-title":"Skeletal muscle-derived extracellular vesicles transport glycolytic enzymes to mediate muscle-to-bone crosstalk","volume":"35","author":"Ma","year":"2023","journal-title":"Cell Metab"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-024-06912-6(2025","article-title":"Updated practice guideline for dual-energy X-ray absorptiometry (DXA)","volume":"52","author":"Slart","year":"2025","journal-title":"Eur J Nucl Med Mol Img"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1007\/s007740200052(2002","article-title":"Differences in bone mineral density, bone mineral content, and bone areal size in fracturing and non-fracturing women, and their interrelationships at the spine and hip","volume":"20","author":"Deng","year":"2002","journal-title":"J Bone Miner Metab"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-006-0747-3(2007","article-title":"Relative contribution of body composition to bone mineral density at different sites in men and women of South Korea","volume":"25","author":"Cui","year":"2007","journal-title":"J Bone Miner Metab"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00774-008-0006-x(2009","article-title":"Association between bone mineral density, lean mass, and fat mass among healthy middle-aged premenopausal women: a cross-sectional study in southern Sri Lanka","volume":"27","author":"Lekamwasam","year":"2009","journal-title":"J Bone Miner Metab"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/205963(2013","article-title":"Relationship between weight, body mass index, and bone mineral density in men referred for dualenergy X-ray absorptiometry scan in Isfahan","volume":"2013","author":"Salamat","year":"2013","journal-title":"Iran J Osteoporos"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1007\/s11914-024-00864-4(2024","article-title":"Fat as a friend or foe of the bone","volume":"22","author":"Gruneisen","year":"2024","journal-title":"Curr Osteoporos Rep"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.13438(2024","article-title":"Longitudinal association between muscle and bone loss: Results of US and Japanese cohort studies","volume":"15","author":"Osawa","year":"2024","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e30735","DOI":"10.1097\/MD.0000000000030735(2022","article-title":"Correlation of muscle mass and bone mineral density in the NHANES US general population, 2017-2018","volume":"101","author":"Qin","year":"2022","journal-title":"Med (Balt)"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2024.01.004(2024","article-title":"A perspective on muscle phenotyping in musculoskeletal research","volume":"35","author":"Foessl","year":"2024","journal-title":"Trends Endocrinol Metab"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.tem.2025.07.004(2025","article-title":"Triglyceride-based lipotoxicity in the pathophysiology of chronic diseases","author":"Liu","year":"2025","journal-title":"Trends Endocrinol Metab"},{"key":"B23","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1007\/s11914-020-00599-y(2020","article-title":"Muscle, bone, and fat crosstalk: the biological role of myokines, osteokines, and adipokines","volume":"18","author":"Kirk","year":"2020","journal-title":"Curr Osteoporos Rep"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.metabol.2024.156056(2024","article-title":"Leptin physiology and pathophysiology in energy homeostasis, immune function, neuroendocrine regulation and bone health","volume":"161","author":"Stefanakis","year":"2024","journal-title":"Metabolism"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.physbeh.2006.05.037(2006","article-title":"The effects of high fat diets on the blood-brain barrier transport of leptin: failure or adaptation","volume":"88","author":"Banks","year":"2006","journal-title":"Physiol Behav"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e408","DOI":"10.1002\/edm2.408","article-title":"The relationship between adipokine levels and bone mass-A systematic review","volume":"6","author":"Mangion","year":"2023","journal-title":"Endocrinol Diabetes Metab"},{"key":"B27","first-page":"i","article-title":"Report of a WHO consultation","volume":"894","year":"2000","journal-title":"World Health Organ Tech Rep Ser"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3390\/medsci9040069(2021","article-title":"Trabecular bone score and bone mineral density in postmenopausal women with morbid obesity-A clinical paradox","volume":"9","author":"Jose","year":"2021","journal-title":"Med Sci (Basel)"},{"key":"B29","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12877-025-05704-3(2025","article-title":"The obesity paradox in osteoporosis risk among older adults is mostly driven by women: a population-based prospective study","volume":"25","author":"Luo","year":"2025","journal-title":"BMC Geriatr"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3390\/ijms241411629(2023","article-title":"Lipid peroxidation as a possible factor affecting bone resorption in obese subjects-preliminary research","volume":"24","author":"Maciejewski","year":"2023","journal-title":"Int J Mol Sci"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.3390\/ijms222413662(2021","article-title":"Obesity and bone: A complex relationship","volume":"22","author":"Rinonapoli","year":"2021","journal-title":"Int J Mol Sci"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23158303(2022","article-title":"Obesity and bone health: A complex relationship","volume":"23","author":"Pi\u00f1ar-Gutierrez","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3390\/ijms23031376(2022","article-title":"Osteoporosis due to hormone imbalance: an overview of the effects of estrogen deficiency and glucocorticoid overuse on bone turnover","volume":"23","author":"Cheng","year":"2022","journal-title":"Int J Mol Sci"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e180073","DOI":"10.1172\/JCI180073(2024","article-title":"Metabolic benefits afforded by estradiol and testosterone in both sexes: clinical considerations","volume":"134","author":"Mauvais-Jarvis","year":"2024","journal-title":"J Clin Invest"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e13862","DOI":"10.1002\/jcsm.13862(2025","article-title":"Delineating life-course percentile curves and normative values of multi-systemic ageing metrics in the United Kingdom, the United States, and China","volume":"16","author":"Zhang","year":"2025","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1038\/s41413-023-00306-4(2024","article-title":"Insights and implications of sexual dimorphism in osteoporosis","volume":"12","author":"Zhang","year":"2024","journal-title":"Bone Res"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e26153","DOI":"10.1097\/MD.0000000000026153(2021","article-title":"Sex-related differences in bone metabolism in osteoporosis observational study","volume":"100","author":"Choi","year":"2021","journal-title":"Med (Balt)"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e0250437","DOI":"10.1371\/journal.pone.0250437(2021","article-title":"An analysis and systematic review of sarcopenia increasing osteopenia risk","volume":"16","author":"Teng","year":"2021","journal-title":"PloS One"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16101(2022","article-title":"Effect of exercise on bone mineral density among patients with osteoporosis and osteopenia: A systematic review and network meta-analysis","volume":"31","author":"Zhang","year":"2022","journal-title":"J Clin Nurs"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1007\/s11914-023-00777-8(2023","article-title":"Exercise to prevent and manage frailty and fragility fractures","volume":"21","author":"Dent","year":"2023","journal-title":"Curr Osteoporos Rep"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1798429\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T05:36:51Z","timestamp":1773207411000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1798429\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":40,"alternative-id":["10.3389\/fendo.2026.1798429"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1798429","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]},"article-number":"1798429"}}