Abstract
Lipedema is a chronic, progressive adipose tissue disorder characterized by disproportionate subcutaneous fat accumulation, pain, edema, and resistance to conventional weight-loss strategies. Although traditionally conceptualized as a disease of adipose expansion, increasing clinical and imaging evidence suggests that functional impairment in advanced lipedema cannot be explained by adipose pathology alone. This narrative, hypothesis-generating review proposes an integrated pathophysiological framework in which inflammatory myosteatosis serves as a mechanistic bridge between lipedema progression and dynapenia. We examine how chronic adipose inflammation, microvascular dysfunction, and impaired lipid mobilization may promote ectopic lipid deposition within skeletal muscle, leading to mitochondrial inflexibility, oxidative stress, and reduced contractile efficiency. Within this model, lipedematous dynapenic myosteatosis may explain the paradox of reduced muscle strength despite preserved or increased limb volume, particularly during the transition from Stage 2.5 to Stage 3. Unlike obesity-associated dynapenia, which is primarily driven by systemic metabolic overload, lipedema-related muscle dysfunction may involve localized adipose-muscle inflammatory crosstalk and mechanical intolerance to exercise. This framework reframes advanced lipedema as a disorder of coupled adipose-muscle dysfunction rather than isolated adipose excess. The model is conceptual and intended to generate testable hypotheses, highlighting the need for future studies incorporating objective measures of muscle quality, mitochondrial function, and inflammatory signaling to clarify mechanisms underlying functional decline.