Table 1:
Summary of Intervention Studies Examining the Effect of Weight Loss on Bone Mineral Density and Metabolism in Older adults with obesity
| Reference | Study Design & Interventions | Sample | Summary of Bone Related Outcomes |
|---|---|---|---|
| Chao et al. (2000) | RCT: 12 months; 2 groups: C vs WL; Ca/Vitamin D supplemented | n=67 women; Age ≥60; BMI ≥27.3 | Weight (−4.3% WL vs −1.1% C †); L2-L4 BMD (+0.9 ± 4.1% WL vs −0.7 ± 4.1% C); Femoral Neck BMD (−1.4 ± 3.0% WL vs −0.8 ± 2.9% C). Markers: No differences between groups, but both groups had significant rises in OC. |
| Villareal et al. (2008) | RCT: 12 months; 2 groups: C vs WL+Ex; Ca/Vitamin D supplemented | n=27 sedentary women and men with mild to moderate frailty; Age ≥65; BMI ≥30 | Weight (−10% WL+Ex vs +1% C †); L1-L4 BMD (+0.9 ± 3.1% WL+Ex vs +1.3 ± 5.8% C); Total Hip BMD (−2.4 ± 2.5% WL+Ex vs +0.1 ± 2.1% C *); Trochanter BMD (−3.3 ± 3.1 WL+Ex vs +0.2 ± 3.3% C *); Intertrochanter BMD (−2.7 ± 3.0% WL+Ex vs +0.3 ± 2.7% C *). Markers: OC and CTX increased from baseline at 6 and 12 months in WL+Ex, but were only significantly different from control at 6 months. |
| Santanasto et al. (2011) | RCT: 6 months; 2 groups: Ex vs WL+Ex; Ca/Vitamin D supplemented | n=36 sedentary women and men; Age ≥60; BMI ≥28 | Weight (−5.5% WL+Ex vs −1.2% Ex †); Total Hip BMD (−0.2 ± 3.4% WL+Ex vs +0.5 ± 1.5% Ex) |
| Shah et al. (2011) | RCT: 12 months; 4 groups: C vs Ex vs WL vs WL+Ex; Ca/Vitamin D supplemented | n=107 sedentary men and women with mild to moderate frailty; Age ≥65; BMI ≥30 | Weight (−9.6% WL and −9.4% WL+Ex vs −0.2% C †); L1-L4 BMD (+1.1 ± 3.0% WL vs +0.8 ± 2.8% WL+Ex vs +0.4 ± 2.8% C); Total Hip BMD (−2.6 ± 2.5% WL vs −1.1 ± 2.6% WL+Ex †); Femoral Neck BMD (−2.3 ± 2.5% WL vs −0.9 ± 4.8% WL+Ex vs −0.1 ± 3.1% C); Trochanter BMD (−2.3 ± 2.5% WL vs −1.1 ± 2.6% WL+Ex vs −0.4 ± 2.3% C). Markers: OC & CTX increased in WL, decreased in Ex, and stable in WL+Ex, C †. |
| Armamento-Villareal et al. (2012) | See Shah et al. (2011) | See Shah et al. (2011) | Weight (See Shah et al. [2011]). Serum Sclerostin levels significantly increased from baseline in the WL group at 6 and 12 months but was unchanged in Ex, WL+Ex, and C groups. |
| Waters et al. (2013) | Follow-up of WL+Ex from Shah et al. (2011) at 6, 12, and 30 months; Ca/Vitamin D supplemented | See Shah et al. (2011) | Weight (−9.9% at 6 months, −11.2% at 12 months, −6.9% at 30 months); L1−L4 BMD no significant changes; Total Hip BMD (−1.4 ± 2.5% at 6 months, −1.9 ± 2.5% at 12 months, −4.5 ± 2.4% at 30 months) |
| Beavers et al. (2017) | Two 5 month RCTs; 2 groups: WL+AT vs WL+RT; Ca/Vitamin D supplemented | n=123 sedentary men and women; Age ≥65; BMI ≥27 | Weight (−8.2% WL+AT vs −5.7% WL+RT); L1−L4 BMD (+1.0 ± 0.5% WL+AT vs +1.2 ± 0.5% WL+RT); Total Hip BMD (−0.7 ± 0.2% WL+AT vs +0.3 ± 0.2% WL+RT *); Femoral Neck BMD (−0.7 ± 0.6% WL+AT vs +1.2 ± 0.6% WL+RT *) |
| Villareal et al. (2017) | RCT: 6 months; 4 groups: C vs WL+AT vs WL+RT vs WL+CT; Ca/Vitamin D supplemented | n=160 sedentary men and women with mild to moderate frailty; Age ≥65; BMI ≥30 | Weight (−9.3% WL+AT and −8.4% WL+RT and −8.6% WL+CT vs −0.9% C †); L1-L4 BMD (+0.2 ± 3.4% WL+AT vs +0.7 ± 3.4% WL+RT vs +0.7 ± 2.7% WL+CT vs +0.9 ± 3.4% C); Total Hip BMD (−2.7 ± 2.5% WL+AT vs −0.6 ± 2.5% WL+RT *) Total Hip BMD (−2.7 ± 2.5% WL+AT vs +0.2 ± 2.5% C †) |
| Kelleher et al. (2017) | RCT: 22 weeks; 2 groups: WL vs WL+Vest | n=37 sedentary men and women; Age ≥65; BMI ≥30 | Weight (−12% WL vs −11% WL+Vest); L1-L4 BMD (+2.0 ± 4.5% WL vs +1.2 ± 2.7% WL+Vest); Total Hip BMD (−1.9 ± 2.1% WL vs −0.6 ± 2.2% WL+Vest); Femoral Neck BMD (− 1.2 ± 3.7% WL vs −1.5 ± 3.6% WL+Vest); Markers: No significant differences between groups. |
*
p<0.05 for the comparison between stated groups
†
p<0.001 for the comparison between stated groups
C = control group
WL = weight loss only group
WL+Ex = weight loss plus exercise training group
WL+AT = weight loss plus aerobic training group
WL+RT = weight loss plus progressive resistance training group
WL+CT = weight loss plus combined training group
WL+Vest = weight loss plus weighted vest group
RCT = randomized controlled trial
BMI = body mass index (in units of kg/m2)
BMD = bone mineral density
NTX = N-terminal telopeptide
BSAP = bone specific alkaline phosphatase
OC = osteocalcin
CTX = C-terminal telopeptide
P1NP = N-terminal propeptide of type 1 collagen