The independent and combined effects of intensive weight loss and exercise training on bone mineral density in overweight and obese older adults with osteoarthritis

Abstract

Objective To determine the effects of dietary-induced weight loss (D) and weight loss plus exercise (D+E) compared to exercise alone (E) on bone mineral density (BMD) in older adults with knee osteoarthritis (OA). Design Data come from 284 older (66.0±6.2 years), overweight/obese (BMI 33.4±3.7 kg/m2), adults with knee OA enrolled in the Intensive Diet and Exercise for Arthritis (IDEA) study. Participants were randomized to 18 months of walking and strength training (E; n=95), dietary-induced weight loss targeting 10% of baseline weight (D; n=88) or a combination of the two (D+E; n=101). Body weight and composition (DXA), regional BMD, were obtained at baseline and 18 months. Results E, D, and D+E groups lost 1.3±4.5 kg, 9.1±8.6 kg and 10.4±8.0 kg, respectively (p<0.01). Significant treatment effects were observed for BMD in both hip and femoral neck regions, with the D and D+E groups showing similar relative losses compared to E (both p<0.01). Despite reduced BMD, fewer overall participants had T-scores indicative of osteoporosis after intervention (9 at 18 months vs. 10 at baseline). Within the D and D+E groups, changes in hip and femoral neck, but not spine, BMD correlated positively with changes in body weight (r=0.21 and 0.54 respectively, both p=<0.01). Conclusions Weight loss via an intensive dietary intervention, with or without exercise, results in bone loss at the hip and femoral neck in overweight and obese, older adults with OA. Although the exercise intervention did not attenuate weight loss associated reductions in BMD, classification of osteoporosis and osteopenia remained unchanged.

Six weeks of conditioning exercise increases total, but not free testosterone in lifelong sedentary aging men

“…Similarly, the ~2% decrease in body fat percentage observed in SED is in line with a previous investigation [25] which reported a of 2.3% reduction following 12 weeks of alpine skiing. SED body mass decreased 1.3% in the present investigation whereas previous investigations have reported a 1.6% decrease following 18 months of combined aerobic and resistance training [41] and no change following 12 weeks of alpine skiing and moderate treadmill running [25,39]. The relatively high body mass loss compared to the previous longer duration study may be attributed to the incorporation of resistance exercise into their exercise training [41], known to cause muscular hypertrophy and therefore attenuate total body mass losses [42].…”

Caloric Restriction for Treatment of Geriatric Obesity: Do the Benefits Outweigh the Risks?

“…Four of the trials analyzed the independent effects of CR on BMD [39, 47, 48, 52]. Two of them found that CR decreased BMD in the hip, but not the spine region, and that the decrease in hip BMD correlated with the magnitude of weight lost [48, 52].…”

“…Two of them found that CR decreased BMD in the hip, but not the spine region, and that the decrease in hip BMD correlated with the magnitude of weight lost [48, 52]. The other two trials either did not observe a significant decline in BMD [47], or did not observe a significantly different decline in BMD between the CR and control groups [39].…”

“…The other two trials either did not observe a significant decline in BMD [47], or did not observe a significantly different decline in BMD between the CR and control groups [39]. As indicated by Beavers et al [52], even though the CR intervention decreased hip BMD, the clinical classification of osteoporosis and osteopenia remained unchanged. Thus, whether the magnitude of BMD loss observed in these trials translates into osteopenia, osteoporosis, and increased fracture risk remains to be determined.…”

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“…Hence avoiding such extreme measures in efforts to reduce osteoarthritis pain in obese cases seems highly recommended. To this end, the use of whole body mass impedance measures and the ability to examine local and general body fat distribution versus lean muscle mass, which can contribute to a high body mass index value along with periodic vitamin D assays, followed by long term carefully designed tailored multi pronged interventions as outlined by Janke et al 59 and Barlow, 60 as well as a focus on diet content, 61 stress control, 62 glucose control 63 and avoidance of reduced bone mineral density effects that can occur post weight loss 64 is highly recommended in this respect, as is careful attention to maximizing mental health through cognitive behavioral therapy 65,66 ( Figure 3) and behavioral therapy combined, 67,68 as well as overall health status, muscle and physical function through non pharmacologic approaches. 69,70 Finally ascertaining the cause of prevailing obesity and intervening accordingly in this respect is strongly advocated.…”