Dr Rosen did a very nice job explaining the complex biology of our fat cells and how they  are derived from the same MSC lineage as osteoblasts.  There are many factors that influence the cells to mature either into an adipocyte or an osteoblast.  There appears to be some plasticity and even later precursors can evolve one way or the other.  Some of the exciting new science was the impact of RANKL/RANK system which impacts the bone marrow adipocytes and could help us understand some of the findings with the rapid bone loss associated with discontinuation of denosumab.  This was clinically important as we are all anxious about our patient stopping denosumab without our knowledge.  PTH analogs are known to push the MSC cells into the osteoblast lineage and that is clearly one of the ways teriparatide and abaloparatide are anabolic to bone.   This is likely the only lecture at the meeting on adipocytes and if you have any interest I would encourage watching the recording if possible.  Dr Rosen is clearly an expert and a good teacher.

We should thank the Oscar Gluck family, friends, ACR and some industry sponsorship for this memorial lecture.  Oscar was a great advocate for more bone content at the ACR and this has been a very successful lectureship


Kelly Krohn MD