Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones

AbstractBackground: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 obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).

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Bone Mineral Density and Fracture Risk in Obese Older Adults 12 Months After Completion of a 6-Month Higher Protein Diet and Exercise Intervention

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_067 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 67-67

Author(s):

Kathryn Porter Starr ◽

Michael Borack ◽

Kenneth Lyles ◽

Marshall Miller ◽

Jamie Rincker ◽

...

Keyword(s):

Bone Mineral Density ◽

Older Adults ◽

Weight Loss ◽

Body Weight ◽

Fracture Risk ◽

G Protein ◽

Bone Mineral ◽

Protein Diet ◽

Mineral Density

Abstract Objectives Weight loss interventions for older adults often reduce bone mineral density (BMD), increasing risk of subsequent detrimental outcomes. This study explored the long-term impact of a higher protein diet plus exercise versus a diet plus exercise control treatment on body weight, bone mineral density at 3 sites, and fracture risk. Methods Obese (BMI 34.3 ± 4.7 kg/m2) older adults (n = 55; age = 70.0 ± 6.1 yrs) with Short Physical Performance Battery (SPPB) score = 9.2 ± 1.4 (out of 12) who completed a 6-month weight loss plus exercise trial were invited to return for assessment 12 months later. The original randomization was to either 0.8 g protein/kg body weight (Control) or 1.2 g protein/kg body weight, predominantly dairy (Protein). The 18-month assessment included BMD by DEXA (Hologic, Horizon model A) for femoral neck (FN), total hip (TH), and spine (lumbar vertebrae 1–4; LS), as well body weight and secondary outcomes for Fracture Risk Assessment Tool (FRAX). Results A total of 38 (69.1%) study completers were assessed at 18 mo. Body weight was lower than baseline for both Control and Protein (P < 0.01), with Control (−4.8%) trending towards better maintenance of weight loss vs Protein (−2.3%) (P = 0.06). BMD at 18 mo. was not different from baseline in both Control and Protein for LS (0.01 ± 0.05 g/cm2 and −0.0002 ± 0.05 g/cm2; P = 0.512), FN (−0.01 ± 0.07 g/cm2 and −.009 ± 0.04 g/cm2; P = 0.814) and TH (−0.012 ± 0.03 g/cm2 and −.008 ± 0.033 g/cm2; P = 0.685). Change in BMD at 18 mo. did not differ by group at any site; the previously reported Protein group increase in LS at 6 mo. was not sustained. For individual fracture risk, between 0 and 18 mo., 6 improved (5 osteopenia to normal, 1 osteoporosis to osteopenia) and 1 worsened (normal to osteopenia but FRAX score below total and hip fracture thresholds). Conclusions The finding that obese older adults can maintain a lower body weight for 12 months without a decline in BMD and no increase in fracture risk amplifies our previous findings of legacy benefits of a short term obesity intervention for older adults. Further study is needed to determine if the protein benefit to LS is sustained if the higher protein intake is continued long term. Funding Sources This study was funded by the National Dairy Council and the US Department of Veterans Affairs Rehabilitation Research and Development Program.

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Bone Mineral Density In Older Adults With T2DM After Exercise Training

Medicine & Science in Sports & Exercise ◽

10.1249/01.mss.0000538489.47576.c3 ◽

2018 ◽

Vol 50 (5S) ◽

pp. 755

Author(s):

Matthew C. Scott ◽

Neil M. Johannsen ◽

Damon L. Swift ◽

Conrad P. Earnest ◽

Timothy S. Church

Keyword(s):

Bone Mineral Density ◽

Older Adults ◽

Exercise Training ◽

Bone Mineral ◽

Mineral Density

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Bone turnover markers and bone mineral density after 12-month weight loss therapy in obese children

Bone Abstracts ◽

10.1530/boneabs.4.p4 ◽

2015 ◽

Author(s):

Joanna Gajewska ◽

Witold Klemarczyk ◽

Jadwiga Ambroszkiewicz ◽

Magdalena Chelchowska ◽

Halina Weker

Keyword(s):

Bone Mineral Density ◽

Weight Loss ◽

Bone Turnover ◽

Bone Mineral ◽

Bone Turnover Markers ◽

Obese Children ◽

Mineral Density ◽

Turnover Markers ◽

Weight Loss Therapy

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Effects of a Weight-Bearing Exercise Training on Bone Mineral Density and Neuromuscular Function of Osteopenic Women

European Journal of Inflammation ◽

10.1177/1721727x1201000318 ◽

2012 ◽

Vol 10 (3) ◽

pp. 427-435 ◽

Cited By ~ 1

Author(s):

D. Marchese ◽

M. D'Andrea ◽

V. Ventura ◽

T. Montalcini ◽

D. Foti ◽

...

Keyword(s):

Quality Of Life ◽

Bone Mineral Density ◽

Muscle Strength ◽

Exercise Training ◽

Bone Turnover ◽

Bone Mineral ◽

Weight Bearing ◽

Neuromuscular Function ◽

Mineral Density

This study was designed to evaluate whether a weight-bearing exercise training played 3 times a week can have benefits on bone mineral density and neuromuscular function in women with a diagnosis of osteopenia. The study enrolled 22 women aged between 45 and 65, with densitometric diagnosis of osteopenia. The participants were randomly assigned to a group of exercise (n=11) and a control group (n=11). The exercise program lasted for 45 min and consisted of a combination of strength exercises that seek to cause a mechanical osteoblastic stimulus by use of gravity, body weight, fall with antigravity reaction, in combination with exercises for the improvement of balance and coordination. The outcome measures used to assess the result on bone mass are the bone Mineralometric DEXA method for femoral head-neck region and lumbar spine and biochemical markers of bone turnover (resorption and neoformation) and for the evaluation of neuromuscular function was chosen to use surface electromyography (sEMG) as an indicator of overall activity and speed activation of lumbar paravertebral muscles and of the lower limbs antigravity muscles, stabilometric analysis and 6' Walk Test. In addition each person enrolled was given EuroQol and ICF core set of osteoporosis, respectively, to assess the quality of life, as well as activity limitations and participation restrictions associated. In the exercise group, mean values and changes in average rates for the balance, muscle strength, walking ability and quality of life, mean bone mineral content and bone turnover markers, corresponding to the assessments made at 0 (before rehabilitation intervention) and Time 1 (program ended), showed a statistically significant improvement. The results of this study demonstrate that a group rehabilitation program of exercises based on gravitational load, aimed to improve muscle strength and trophism, coordination and balance, can provide advantages of unquestionable importance, not only on the slope of increase bone mass of neuromuscular function and reducing risk of falling, but on health in general.

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