Does bone loss begin after weight loss ends? Results 2 years after weight loss or regain in postmenopausal women

Abstract

Objective Short-term weight loss is accompanied by bone loss in postmenopausal women. The longer-term impact on bone in the reduced overweight/obese woman compared to those who regain their weight was examined in this study using a case-control design. Methods Postmenopausal women (n = 42, body mass index of 28.3 ± 2.8 kg/m2; 60.7 ± 5.5 y) were recruited 2 years after the start of a 6 month weight loss trial and those who maintained their weight (WL-M) were matched to a cohort who regained weight (WL-R). Serum hormones and bone markers were measured in a subset. Bone mineral density (BMD) at the femoral neck (FN), trochanter, spine, radius, and total body and soft tissue composition were taken at baseline, 0.5 and 2 years. Results During WL, both groups lost 9.3 ± 3.4% body weight with no significant difference between groups. After weight loss, weight change was −0.1 ± 2.7 % and 6.0 ± 3.3% in the WL-M (n=22) and WL-R (n=20) groups, respectively. After 2 years, both groups lost BMD at the FN and trochanter (p ≤ 0.01), whereas only the WL-M group reduced BMD at the 1/3 radius (p < 0.001). There was a greater BMD loss at the trochanter (−6.8 ± 5.7%) and the 1/3 radius (−4.5 ± 3.3%) in the WL-M compared to the WL-R group after 2 years. Multiple linear regression showed that change in leg fat mass (but not trunk fat) contributed to trochanter BMD loss (p <0.05). Conclusions After 2 years, there is no BMD recovery of weight reduction-induced bone loss, irrespective of weight-regain. These data suggest that the period after weight loss may be an important point in time to prevent bone loss for both those who maintain or regain weight.

Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials

“…This prevented us from being able to assess whether the changes that were observed immediately after finishing the weight-loss diet persisted or resolved once the dietary intervention had ceased. Of the studies that did include a follow-up time point, (21,23,25,27,28,30,39,74) decreases in BMD of the total hip, (23,30,74) lumbar spine, (25,28,30) and total body (21,27,28,30,39) were still present when measured at 3 to 21 months after completion of the dietary weight-loss intervention, raising potential concerns about the long-term impact of repeated weight-loss diets on bone. Hence, it would be important that future studies investigate the longitudinal effects of dietary weight-loss interventions on bone, as in two current trials by our research team.…”

“…Corresponding authors were contacted if any required data was not available from the publication or was published in a format different from that required for this meta-analysis. (20,(22)(23)(24)(25)28,(35)(36)(37)39,(42)(43)(44)(45)(46)(47)(69)(70)(71)73,74) For authors from whom we did not receive a response, (24,49,75) data for their publications were analyzed qualitatively rather than quantitatively.…”

“…Of the studies that have investigated changes in bone mass in response to diet-induced weight loss in overweight or obese adults, the results have been highly variable, with increases, (20)(21)(22)(23)(24) decreases, (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) and no change (22,24,26,30,33,(41)(42)(43)(44)(45)(46)(47)(48)(49) in bone mass being reported. Thus, attempting to draw sound conclusions from these mixed results is extremely difficult.…”

Weight loss and bone mineral density

“…Bone mineral density decreases with diet-induced weight loss [18–20], and at least in post-menopausal women, does not return to pre-weight loss levels with weight regain [20]. Although it is impossible to understand how age-related losses in BMD contribute to the losses observed across the 2 year follow-up, these findings suggest that weight loss produces long-term impairments in BMD of postmenopausal women.…”

Bioimpedance analysis vs. DEXA as a screening tool for osteosarcopenia in lean, overweight and obese Caucasian postmenopausal females

“…These correlations confirm previous studies that have disputed the value of weight loss in postmenopausal women granted that in the absence of physical activity the loss may involve not only fat but skeletal muscle and bone mass. 43,44 Our findings indicate the negative impact of estrogen decrease not only on bone mass, but also possibly on other Figure 7. Fat mass in kgs to skeletal muscle mass in kgs ratio shown as a marker of concordance between fat and muscle mass and absence of frailty in the three groups.…”