LEP and obesity due to melanocortin 4 receptor deficiency: Russell et al. (2010) proposed that VAT was a negative predictor of spine BMD, apparent BMD, systemic BMD and bone mineral content for obese adolescent girls aged 12–18 years (Katzmarzyk et al., 2012). Importantly, VAT/SAT, adipokines, cytokines, E-selectin, and adiponectin were negative predictors of bone density, while leptin was positive. Consequently, VAT is an independent negative determining factor of bone density in obesity (Jurimae et al., 2008; Agbaht et al., 2009; Russell et al., 2010; Bredella et al., 2011a).