Background: The conventional concept of positive association between general obesity and bone health was challenged in recent studies reporting the different effects of specific fat deposition on bone health. In the present study, we investigated the association between epicardial fat and bone health.

Methods: We measured echocardiographic epicardial fat thickness (EFT) and bone mineral content (BMC) in a twin-family cohort of Koreans ( n = 1,198; 525 men, 460 pre- and 213 post-menopausal women). A total 121 pairs of monozygotic twin (MZ) and 404 pairs of dizygotic twin and sibling pairs (DZ/Sib) were included.

Results: EFT was positively associated with BMC in total, as well as in three subgroups (β = 0.107, 0.076, and 0.058 for men, pre-, and post-menopausal women, respectively). The positive association between EFT and BMC remained for DZ/Sib difference analysis, but was absent for MZ comparisons. The positive association between BMI and BMC was consistent for DZ/Sib and MZ difference analysis. After adjusting for the effect of general obesity via BMI, the association between BMC and EFT was statistically non-significant (β = 0.020, 0.000, and −0.009 for men, pre-, and post-menopausal women, respectively).

Conclusion: Our findings do not support epicardial fat’s beneficial effects on bone health, whereas general adiposity has an osteotropic effect. The association between EFT and BMC is through common genetic component factors.