Effect of Weight Loss and Exercise Therapy on Bone Metabolism and Mass in Obese Older Adults: A One-Year Randomized Controlled Trial

Background: Although weight loss and exercise ameliorates frailty and improves cardiac risk factors in obese older adults, the long-term effect of lifestyle intervention on bone metabolism and mass is unknown. Objective: The objective was to evaluate the effects of diet-induced weight loss in conjun...

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Published in:The journal of clinical endocrinology and metabolism 2008-06, Vol.93 (6), p.2181-2187
Main Authors: Villareal, Dennis T, Shah, Krupa, Banks, Marian R, Sinacore, David R, Klein, Samuel
Format: Article
Language:English
Subjects:
Aged
Biological and medical sciences
Body Weight - physiology
Bone and Bones - metabolism
Bone and Bones - pathology
Bone Density
Bone Resorption - prevention & control
Combined Modality Therapy
Diet, Reducing
Endocrinopathies
Exercise Therapy
Feeding. Feeding behavior
Female
Fundamental and applied biological sciences. Psychology
Humans
Male
Medical sciences
Muscle Strength - physiology
Obesity - pathology
Obesity - therapy
Organ Size - physiology
Original
Physical Endurance - physiology
Time Factors
Vertebrates: anatomy and physiology, studies on body, several organs or systems
Vertebrates: endocrinology
Weight Loss - physiology
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Summary:Background: Although weight loss and exercise ameliorates frailty and improves cardiac risk factors in obese older adults, the long-term effect of lifestyle intervention on bone metabolism and mass is unknown. Objective: The objective was to evaluate the effects of diet-induced weight loss in conjunction with exercise on bone metabolism and mass in obese older adults. Design and Setting: We conducted a one-year randomized, controlled clinical trial in a university-based research center. Participants: Twenty-seven frail, obese (body mass index = 39 ± 5 kg/m2), older (age 70 ± 5 yr) adults participated in the study. Intervention: Participants were randomly assigned to diet and exercise (treatment group; n = 17) or no therapy (control group; n = 10). Outcome Measures: Body weight decreased in the treatment group but not in the control group (−10 ± 2 vs. +1 ± 1%, P < 0.001). Compared with the control group, the treatment group had greater changes in bone mass, bone markers, and hormones, including 1) bone mineral density (BMD) in total hip (0.1 ± 2.1 vs. −2.4 ± 2.5%), trochanter (0.2 ± 3.3 vs. −3.3 ± 3.1%), and intertrochanter (0.3 ± 2.7 vs. −2.7 ± .3.0%); 2) C-terminal telopeptide (12 ± 35 vs. 101 ± 79%) and osteocalcin (−5 ± 15 vs. 66 ± 61%); and 3) leptin (2 ± 12 vs. −30 ± 25%) and estradiol (0.1 ± 14% vs. −14 ± 21%) (all P < 0.05). Changes in weight (r = 0.55), bone markers (r = −0.54), and leptin (r = 0.61) correlated with changes in hip BMD (all P < 0.05). Conclusion: Weight loss, even when combined with exercise, decreases hip BMD in obese older adults. It is not known whether the beneficial effects of weight loss and exercise on physical function lower the overall risk of falls and fractures, despite the decline in hip BMD.
ISSN:0021-972X
1945-7197
DOI:10.1210/jc.2007-1473