Congenital lipodystrophy induces severe osteosclerosis

Berardinelli-Seip congenital generalized lipodystrophy is associated with increased bone mass suggesting that fat tissue regulates the skeleton. Because there is little mechanistic information regarding this issue, we generated "fat-free" (FF) mice completely lacking visible visceral, subcutaneous and brown fat. Due to robust osteoblastic activity, trabecular and cortical bone volume is markedly enhanced in these animals. FF mice, like Berardinelli-Seip patients, are diabetic but normalization of glucose tolerance and significant reduction in circulating insulin fails to alter their skeletal phenotype. Importantly, the skeletal phenotype of FF mice is completely rescued by transplantation of adipocyte precursors or white or brown fat depots, indicating that adipocyte derived products regulate bone mass. Confirming such is the case, transplantation of fat derived from adiponectin and leptin double knockout mice, unlike that obtained from their WT counterparts, fails to normalize FF bone. These observations suggest a paucity of leptin and adiponectin may contribute to the increased bone mass of Berardinelli-Seip patients. Author summary Berardinelli-Seip congenital generalized lipodystrophy is a human disorder associated with increased bone mass suggesting that fat, per se, regulates the skeleton. To test this hypothesis we generated a murine model of congenital generalized lipodystrophy in which both brown and white adipose tissue are entirely depleted during embryogenesis. These fat-free (FF) exhibit a marked increase in bone mass throughout their body. The increased bone mass represents stimulation of bone formation and not retarded bone breakdown. Additionally, the increased bone mass of FF mice markedly increases skeletal strength and resistance to fracture. Like patients with congenital lipodystrophy, FF mice are diabetic but their metabolic state does not contribute to their increased bone mass. To identify the fat-produced molecules regulating bone mass we transplanted genetically modified adipose tissue into FF mice which established that absence of the fat-produced molecules, adiponectin and leptin, significantly enhances bone formation. These observations suggest that reducing the combined effect of adiponectin and leptin, on bone, will increase its abundance and fracture resistance.