Obesity is associated with suppressed bone turnover: a systematic review and meta-analysis

Background: Obesity is an increasingly serious public health issue on a global scale. Although there is increasing research on the relationship between obesity and biochemical markers of bone turnover, this relationship is complex and unclear. We conducted a systematic review and meta-analysis aimed at comparing the concentrations of biochemical markers of bone turnover between individuals with obesity and those with normal-weight. Method: A systematic search was conducted using the PubMed, EMBASE, Web of Science, Cochrane Library, and EBSCO databases from database inception to December 15, 2025. Two researchers screened the literature according to the inclusion and exclusion criteria and extracted valid data for quality evaluation. Results: The results ultimately included 14 articles with a total of 4612 subjects. Compared with normal-weight individuals, individuals with obesity showed no significant difference in alkaline phosphatase (ALP) levels. Procollagen type I N-terminal propeptide (PINP) levels were significantly reduced in individuals with obesity. Osteocalcin (OCN) levels were also decreased overall, but subgroup analysis showed that this reduction was significant in children and adolescents, whereas no significant difference was observed in adults. No significant difference was observed in C-terminal telopeptide of type I collagen (CTX-I) or N-terminal telopeptide of type I collagen (NTX) levels. Conclusion: This meta-analysis suggests that obesity is associated with suppressed bone turnover, mainly reflected by reduced levels of bone formation markers. PINP levels were significantly decreased in individuals with obesity, whereas the reduction in OCN appeared to be age-dependent, with significant suppression observed in children and adolescents but not in adults. However, the robustness of the bone resorption results is insufficient and requires further validation through additional studies. Further studies are needed to clarify the mechanisms by which obesity affects skeletal health and to identify potential targets for clinical intervention.