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Clifford J. Rosen, MD, Anne Klibanski, MD 

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1 Bone, Fat, and Body Composition: Evolving Concepts in the Pathogenesis of Osteoporosis 
Clifford J. Rosen, MD, Anne Klibanski, MD  The American Journal of Medicine  Volume 122, Issue 5, Pages (May 2009) DOI: /j.amjmed Copyright © 2009 Elsevier Inc. Terms and Conditions

2 Figure 1 The neuroendocrine circuit that ties body composition to the hypothalamus through several interconnecting networks. The hypothalamus processes incoming signals from fat, primarily leptin. Several nuclei integrate signals through neuropeptides releasing sympathetic activity, which in turn regulates insulin secretion and skeletal remodeling. Osteocalcin, a bone-specific protein, can regulate insulin secretion and sensitivity. The negative feedback signals to bone from the islets and fat tissue have not been defined. The American Journal of Medicine  , DOI: ( /j.amjmed ) Copyright © 2009 Elsevier Inc. Terms and Conditions


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