Moderate weight loss in obese and overweight men preserves bone quality

Pop, L. Claudia; Sukumar, Deeptha; Tomaino, Katherine; Schlussel, Yvette; Schneider, Stephen H.; Gordon, Chris; Shapses, Sue A.

doi:10.3945/ajcn.114.088534

Cited by 41 publications

(26 citation statements)

References 47 publications

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“…(15,16) Even voluntary weight loss in the setting of overweight or obesity predicted incident bone loss and fracture at the hip in older women (15) and incident hip bone loss in men. (16) A number of RCTs, most of 6 to 12 months' duration, have examined the effects of weight loss interventions on BMD in overweight or obese older adults (17)(18)(19)(20)(21)(22)(23) In general, the weight loss groups have experienced decreases in body weight of 9% to 10% and decreases in BMD of about 2%. Loss of bone mass in these trials is more consistently shown at the hip than spine.…”

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confidence: 99%

Decline in Bone Mass During Weight Loss: A Cause for Concern?

Schafer

2015

Journal of Bone and Mineral Research

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C linicians spend countless hours counseling obese patients about weight loss, and the scientific literature is teeming with studies comparing the effectiveness of diets for attaining and maintaining weight loss in the setting of obesity. Among bone and mineral researchers, there is increasing interest in understanding the skeletal effects of both obesity and the weight loss undertaken to treat it. (1,2) However, the treatment of obesity is not the only potential indication for caloric restriction (CR). For years, some individualsmany already at normal weight-have pursued CR with the desire to slow the biological rate of aging and to increase longevity. (3) This potential was explored in the Comprehensive Assessment of Long-term Effects of Reduced Intake of Energy (CALERIE) phase 2 trial, a 2-year randomized controlled trial (RCT) that tested the feasibility, safety, and efficacy of CR in nonobese young and middle-aged adults. Effects on the primary outcomes of resting metabolic rate and core body temperature have been published. (4) In this issue of the Journal of Bone and Mineral Research, Villareal and colleagues (5) report the effects of the CR intervention on bone metabolism and BMD.CALERIE phase 2 enrolled adults 20 to 50 years old with BMI 22 to 28 kg/m 2 , randomizing 218 participants to CR or ad libitum control diets. The CR intervention was designed to produce weight loss during the first year followed by weight maintenance during the second year. The CR group achieved an average 11.7% CR over the 2 years, resulting in a mean weight loss from baseline of 8.4 kg at 12 months (an 11.5% decrease) and 7.5 kg at 24 months (a 10% decrease). Weight change in the control group was negligible. Villareal and colleagues (5) show that spine and proximal femur BMD declined significantly in the CR group, with a 2% decline by 2 years. Markers of bone resorption increased at 6 and 12 months in the CR group, and the bone formation marker bone-specific alkaline phosphatase decreased at 12 and 24 months.Should we be concerned that this decline in bone mass will mean a higher risk of fracture in the future? Or, need we not be concerned because the decline is simply the skeleton's appropriate adaptation to a new, lower body weight? Before attempting to answer these questions, it may be useful to review what we have learned from other human studies about the skeletal effects of weight loss.Most of the published studies addressing weight loss and bone health have examined older adults. Large epidemiologic studies have shown clearly that weight loss is associated with higher fracture risk in older adults, (6)(7)(8)(9)(10)(11)(12)(13)(14) although such studies are generally limited by the possibility that the weight loss was in part the unintentional result of illness that also negatively impacted bone. This potential for confounding prompted the questioning of older women and men in two large prospective cohort studies about weight loss intention. (15,16) Even voluntary weight loss in the setting of overweight or obesity pred...

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confidence: 99%

Decline in Bone Mass During Weight Loss: A Cause for Concern?

Schafer

2015

Journal of Bone and Mineral Research

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“…While it is appreciated that bone loss occurs throughout the entire lower extremity, the trabecular area above the knee (DF) and below the knee (PT) is a ROI commonly studied because these areas have the highest prevalence of fracture [67], because wheelchair-related accidents are the most common events that make the DF and PT vulnerable to impact and fracture in person with SCI [13,28,33,68]. Although DXA is the most affordable and accessible method to measure BMD at the DF and PT, pQCT is regarded as the more informative and sensitive method.…”

Section: Advanced Bone Imaging: Ct and Mrimentioning

confidence: 99%

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

et al. 2016

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Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.

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“…Three randomized controlled trials (RCT), two with large female study populations (n ≥ 350), were conducted [46, 49, 50], and three intervention studies [47, 48, 51] of which only one recruited men and women [47]. …”

Section: Diet-induced Weight Loss and Vitamin Dmentioning

confidence: 99%

“…A non-randomized intervention study with a small population size of 38 men, followed participants up to 6 months in either a weight loss program or weight maintenance [51]. The weight loss program was designed based on a standard behavior modification nutrition education weight loss program including an individualized caloric intake (500–600 kcal deficit/day) [51].…”

Section: Diet-induced Weight Loss and Vitamin Dmentioning

confidence: 99%

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A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status

et al. 2017

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Obesity is a major global health problem and has been associated with vitamin D deficiency. Intentional weight loss may alter vitamin D status and, conversely, vitamin D supplementation has been hypothesized to aid in weight loss. A systematic literature search in PubMed/Medline identified 3,173 articles of which 37 studies (randomized controlled trials (RCT) (n=17), non-RCTs (n=20)) are summarized as effect of: (I) diet-induced weight loss on vitamin D status (n=7), (II) vitamin D supplementation on diet-induced weight loss (n=11), (III) surgery-induced weight loss on vitamin D status (n=15), and (IV) vitamin D supplementation after surgery-induced weight loss on vitamin D status (n=5). While all studies on the effect of diet-induced weight loss on vitamin D status have consistently reported increased vitamin D levels, the targeted percentage of weight loss that is necessary for an increase has varied between 5% and >10%. N=11 RCTs testing the effect of vitamin D supplementation observe that vitamin D supplementation does not result in increased weight loss, but may affect body fat loss. Vitamin D deficiency and subsequent hyperparathyroidism have been detected in post-surgery patients, and there is evidence that vitamin D supplementation improves these post-surgery complications.. We review the current evidence addressing the role of vitamin D status and supplementation in diet- and surgery induced weight loss. Subsequently, we highlight gaps in current research and suggest directions for future research including differences in vitamin D supplementation dosages, indoor vs. outdoor exercise, and the assessment of vitamin D status in different body pools.

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Moderate weight loss in obese and overweight men preserves bone quality

Abstract: Moderate WL in overweight and obese men did not decrease BMD at any anatomical site or alter cortical and trabecular bone and geometry. Also, despite increased BMD at some sites when maintaining excess body weight, cortical bone showed a trend in the opposite direction.

Cited by 41 publications

References 47 publications

Decline in Bone Mass During Weight Loss: A Cause for Concern?

Decline in Bone Mass During Weight Loss: A Cause for Concern?

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

A systematic review of the interrelation between diet- and surgery-induced weight loss and vitamin D status

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