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

Zibellini, Jessica; Seimon, Radhika V.; Lee, Crystal; Gibson, Alice A.; Hsu, Michelle; Shapses, Sue A.; Nguyen, Tuan V.; Sainsbury, Amanda

doi:10.1002/jbmr.2564

Cited by 115 publications

(114 citation statements)

References 99 publications

(293 reference statements)

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“…These reductions in total hip BMD were between 0.010 and 0.015 g/cm 2 , which corresponds to an approximate change of 1%-1.5% from pretreatment values [34]. While statistically significant, these diet-induced reductions in hip BMD are considerably less than those associated with bariatric surgery (RYGB specifically), which showed a decline of 8%-11% from presurgical values in the first 12 months post surgery [10,50,56,59,60].…”

Section: Effects Of Dietary Restriction On Bonementioning

confidence: 85%

“…Similarly to bariatric surgery studies, a recent metaanalysis found a significant reduction in hip BMD after diet-induced weight loss interventions of 6-24 (but not 3) months in duration [34]. These reductions in total hip BMD were between 0.010 and 0.015 g/cm 2 , which corresponds to an approximate change of 1%-1.5% from pretreatment values [34].…”

Section: Effects Of Dietary Restriction On Bonementioning

confidence: 93%

“…undergoing dynamic changes in body weight) [33]. These imprecisions are due to several reasons, notably difficulties in positioning patients/participants on the scanning bed, fractures in the vertebrae, which heighten apparent spinal BMD, and artifact errors caused by changing amounts of fat tissue surrounding bones [10,12,34]. Indeed, the presence of fat around bone can result in unpredictable errors in DXA bone measurements of up to 20%, as determined by experiments where phantom bone models or lean participants were wrapped with plastic bags containing semi-solid fat [33,35].…”

Section: Analysis Of Bone Dual Energy X-ray Absorptiometry (Dxa)mentioning

confidence: 99%

“…In our recent systematic review and meta-analysis [34], we noted that markers of bone turnover that have been commonly used include N-terminal propeptide of type I procollagen (P1NP) and osteocalcin for bone formation, and C-terminal telopeptide of type I collagen (CTX) and N-terminal telopeptide of type I collagen (NTX) for bone resorption [40][41][42]. P1NP and CTX have recently been recommended as the standardized reference markers for bone formation and resporption, respectively [40][41][42].…”

Section: Markers Of Bone Turnovermentioning

confidence: 99%

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Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Harper

Pattinson

Fernando

et al. 2016

Hormone Molecular Biology and Clinical Investigation

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Background: New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. Materials and methods: This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. Results and conclusions: All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) -but not BMD -and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in

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Section: Effects Of Dietary Restriction On Bonementioning

confidence: 85%

Section: Effects Of Dietary Restriction On Bonementioning

confidence: 93%

Section: Analysis Of Bone Dual Energy X-ray Absorptiometry (Dxa)mentioning

confidence: 99%

Section: Markers Of Bone Turnovermentioning

confidence: 99%

See 2 more Smart Citations

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Harper

Pattinson

Fernando

et al. 2016

Hormone Molecular Biology and Clinical Investigation

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“…1,2) Among these obesity-related complications, renal disease has been reported to be a significant issue. 3) High-fat diet induces renal lipid metabolism disorder, renal lipotoxicity and subsequent renal injuries.…”

mentioning

confidence: 99%

Resveratrol Protects against High-Fat Diet Induced Renal Pathological Damage and Cell Senescence by Activating SIRT1

Zhang

et al. 2016

Biological & Pharmaceutical Bulletin

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Obesity-related renal diseases have been a worldwide issue. Effective strategy that prevents high fat-diet induced renal damage is of great significance. Resveratrol, a natural plant polyphenol, is famous for its antioxidant activity, cardioprotective effects and anticancer properties. However whether resveratrol can play a role in the treatment of renal diseases is unknown. In this study, we added resveratrol in normal glucose or high glucose medium and provide evidences that resveratrol protects against high-glucose triggered oxidative stress and cell senescence. Moreover, mice were fed with standard diet, standard diet plus resveratrol, high-fat diet or high-fat diet plus resveratrol for 3 months, and results show that resveratrol treatment prevents high-fat diet induced renal pathological damage by activating SIRT1, a key member in the mammalian sirtuin family that response to calorie restriction life-extension method. This research confirms the potential role of resveratrol in the treatment of renal diseases and may provide an effective and convenient method to mimic the beneficial effects of calorie restriction.

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Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment

Jensen,

Sørensen,

Sandsdal

et al. 2024

JAMA Netw Open

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ImportanceA major concern with weight loss is concomitant bone loss. Exercise and glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent weight loss strategies that may protect bone mass despite weight loss.ObjectiveTo investigate bone health at clinically relevant sites (hip, spine, and forearm) after diet-induced weight loss followed by a 1-year intervention with exercise, liraglutide, or both combined.Design, Setting, and ParticipantsThis study was a predefined secondary analysis of a randomized clinical trial conducted between August 2016 and November 2019 at the University of Copenhagen and Hvidovre Hospital in Denmark. Eligible participants included adults aged 18 to 65 years with obesity (body mass index of 32-43) and without diabetes. Data analysis was conducted from March to April 2023, with additional analysis in February 2024 during revision.InterventionsAfter an 8-week low-calorie diet (800 kcal/day), participants were randomized to 1 of 4 groups for 52 weeks: a moderate- to vigorous-intensity exercise program (exercise alone), 3.0 mg daily of the GLP-1 RA liraglutide (liraglutide alone), the combination, or placebo.Main Outcomes and MeasuresThe primary outcome was change in site-specific bone mineral density (BMD) at the hip, lumbar spine, and distal forearm from before the low-calorie diet to the end of treatment, measured by dual-energy x-ray absorptiometry in the intention-to-treat population.ResultsIn total, 195 participants (mean [SD] age, 42.84 [11.87] years; 124 female [64%] and 71 male [36%]; mean [SD] BMI, 37.00 [2.92]) were randomized, with 48 participants in the exercise group, 49 participants in the liraglutide group, 49 participants in the combination group, and 49 participants in the placebo group. The total estimated mean change in weight losses during the study was 7.03 kg (95% CI, 4.25-9.80 kg) in the placebo group, 11.19 kg (95% CI, 8.40-13.99 kg) in the exercise group, 13.74 kg (95% CI, 11.04-16.44 kg) in the liraglutide group, and 16.88 kg (95% CI, 14.23-19.54 kg) in the combination group. In the combination group, BMD was unchanged compared with the placebo group at the hip (mean change, −0.006 g/cm2; 95% CI, −0.017 to 0.004 g/cm2; P = .24) and lumbar spine (−0.010 g/cm2; 95% CI, −0.025 to 0.005 g/cm2; P = .20). Compared with the exercise group, BMD decreased for the liraglutide group at the hip (mean change, −0.013 g/cm2; 95% CI, −0.024 to −0.001 g/cm2; P = .03) and spine (mean change, −0.016 g/cm2; 95% CI, −0.032 to −0.001 g/cm2; P = .04).Conclusions and RelevanceIn this randomized clinical trial, the combination of exercise and GLP-1RA (liraglutide) was the most effective weight loss strategy while preserving bone health. Liraglutide treatment alone reduced BMD at clinically relevant sites more than exercise alone despite similar weight loss.Trial RegistrationEudraCT: 2015-005585-32

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

Cited by 115 publications

References 99 publications

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Resveratrol Protects against High-Fat Diet Induced Renal Pathological Damage and Cell Senescence by Activating SIRT1

Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment

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