Zhu L, et al. - In this investigation, researchers identified the association of insulin resistance with marrow adiposity using chemical shift-encoded water–fat MRI in 75 newly diagnosed type 2 diabetes (T2D) and 20 nondiabetic postmenopausal women. For this analysis, they measured vertebral proton density fat fraction (PDFF) by 3T-MRI. By dual-energy X-ray absorptiometry, bone mineral density (BMD), whole body fat mass and lean mass were determined. Using the homeostasis model assessment of insulin resistance (HOMA-IR), insulin sensitivity was estimated. In women with T2D, lumbar spine PDFF was higher than those without diabetes. The vertebral PDFF and BMD had a consistent inverse association. In postmenopausal women with newly diagnosed T2D independently of body compositions, elevated HOMA-IR was associated with higher marrow fat fraction.