Adipose tissue is a dynamic component of the bone marrow, regulating skeletal remodelling and secreting paracrine and endocrine factors that can affect haematopoiesis, as well as potentially nourishing the bone marrow during periods of stress. Bone marrow adipose tissue is regulated by multiple factors, but particularly nutrient status. In this Review, we examine how bone marrow adipocytes originate, their function in normal and pathological states and how bone marrow adipose tissue modulates whole-body homoeostasis through actions on bone cells, haematopoietic stem cells and extra-medullary adipocytes during nutritional challenges. We focus on both rodent models and human studies to help understand the unique marrow adipocyte, its response to the external nutrient environment and its effects on the skeleton. We finish by addressing some critical questions that to date remain unanswered.
Adipocytes are critical cellular components of the bone marrow that are regulated by local and systemic factors.
Bone marrow adipocytes have unique origins and distinct functions that are distinguishable from extra-medullary adipocytes.
In mice and humans, both axial and appendicular bone marrow adipose tissue increase with age and in response to environmental, nutritional and endocrine factors.
Both a high-fat diet and caloric restriction enhance the recruitment and differentiation of marrow adipocytes, although their function might differ by nutrient stores.
A unique marrow adipocyte-like precursor probably serves as a source of mature bone marrow adipocytes.
Increased bone marrow adipose tissue can drive bone loss during high dietary intake or can protect the skeleton during caloric restriction.
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The authors acknowledge the support of National Institute of Diabetes and Digestive and Kidney Diseases R24 092759-09.
The authors declare no competing interests.
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Rosen, C.J., Horowitz, M.C. Nutrient regulation of bone marrow adipose tissue: skeletal implications of weight loss. Nat Rev Endocrinol 19, 626–638 (2023). https://doi.org/10.1038/s41574-023-00879-4