Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis

Abstract

Background Weight-loss-induced fat loss improves cardiometabolic health in individuals with overweight and obesity; however, weight loss can also result in bone loss and increased fracture risk. Weight-loss-induced bone loss may be attenuated with exercise. Our aim was to compare changes in bone mineral density (BMD) in adults with overweight and obesity who undertook diet-induced weight loss alone or in combination with exercise. Methods We included randomized controlled trials (RCTs) in adults with overweight or obesity (aged ≥18 years; body mass index ≥25 kg/m 2 ) that prescribed diet-induced weight loss alone or in combination with supervised exercise, and measured any bone structural parameters. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random-effects meta-analyses determined mean changes and net mean differences (95% confidence intervals (95%CIs)) in the percentage of areal BMD (aBMD) change between groups. Results We included 9 RCTs. Diet-induced weight loss led to significant losses in femoral neck aBMD (mean change: −1.73% (95%CI: −2.39% to −1.07%), p < 0.001) and total hip aBMD (−2.19% (95%CI: −3.84% to −0.54%), p = 0.009). Femoral neck aBMD losses were significantly greater in the diet-induced weight loss group compared to the exercise plus diet-induced weight loss group (net difference: −0.88% (95%CI: −1.73% to −0.03%)); however, there were no differences in aBMD changes at any other skeletal site: total hip (−1.96% (95%CI: −4.59% to 0.68%)) and lumbar spine (−0.48% (95%CI: −1.81% to 0.86%)). aBMD changes did not differ significantly according to exercise modality (resistance exercise, aerobic exercise, or a combination of the two) during diet-induced weight loss. Conclusion Diet-induced weight loss led to greater femoral neck bone loss compared to diet-induced weight loss plus exercise. Bone loss at the total hip and lumbar spine was not attenuated by exercise during diet-induced weight loss. The lack of consistent skeletal benefits may be due to the insufficient duration and/or training intensities of most exercise interventions. Additional RCTs with appropriate, targeted exercise interventions should be conducted.

Association of T2DM、Serum Glucose、HbA1c With Lumbar Spine Bone Mineral Density in 40-59 years adults: A Cross Sectional Study Based on the 2011-2018 NHANES Database

“…Some researchers believed that BMD was positively correlated to BMI. We can believe that the increase of BMD is a physiological phenomenon to adapt to the current physical load [6, 21,22]. However, the risk of fracture of T1DM or T2DM patients is higher than that of normal people [4,6,[23][24][25][26].…”

Effects of Intermittent Fasting on Cardiometabolic Health: An Energy Metabolism Perspective

“…Fat-free mass loss is known to impair physical functionality, cardiometabolic health and may be a risk factor for weight regain and increased fatness [ 42 , 63 , 64 ]. This side effect of IF may be counteracted, at least in part, by exercise, in particular, resistance training since it is known to increase skeletal muscle mass [ 109 , 110 ].…”

Body composition changes at 12 months following different surgical weight loss interventions in adults with obesity: A systematic review and meta‐analysis of randomized control trials

“…A disadvantage of successful weight loss interventions is that they often result in significant bone and muscle loss, 7,8 and this may lead to negative outcomes including increased fracture risk 9,10 . Maintenance of lean muscle mass is beneficial for metabolic health and decreases fracture risk 11–13 .…”

“…6 The mechanism by which weight loss occurs varies between procedures, but typically involves restriction of food intake, as well as a change in hormonal and signaling pathways that affect appetite and metabolism. 6 A disadvantage of successful weight loss interventions is that they often result in significant bone and muscle loss, 7,8 and this may lead to negative outcomes including increased fracture risk. 9,10 Maintenance of lean muscle mass is beneficial for metabolic health and decreases fracture risk.…”