The role of bone marrow adipose tissue evaluation in improving osteoporotic fracture risk assessment

Osteoporosis represents a major global health burden, and emerging data suggest that bone marrow adipose tissue (BMAT) may contribute to skeletal fragility beyond bone mineral density (BMD). BMAT varies with age, sex, and skeletal site, and recent advances in MRI- and HR-pQCT–based techniques allow accurate quantification. Although BMAT is consistently inversely associated with BMD, evidence linking BMAT to fractures is heterogeneous. Cross-sectional and longitudinal studies have indicated the limited added predictive value of BMAT over established clinical risk factors and BMD. Large-scale imaging and genetic analyses reinforce the biological relevance of BMAT but not its clinical utility. Future research should clarify the role of BMAT in specific secondary osteoporosis settings and in combination with advanced analytical approaches.