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/m2) 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.
RAS ID
38905
Document Type
Other
Date of Publication
2021
Volume
10
Issue
5
Funding Information
National Health and Medical Research Council RD Wright Biomedical Career Development Fellowship Research and Training Program Scholarship
PubMed ID
34004388
School
School of Medical and Health Sciences
Grant Number
NHMRC Number : GNT1174886
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Publisher
Elsevier
Comments
Mesinovic, J., Jansons, P., Zengin, A., de Courten, B., Rodriguez, A. J., Daly, R. M., . . . Scott, D. (2021). Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis. Journal of Sport and Health Science, 10(5), 550-559. https://doi.org/10.1016/j.jshs.2021.05.001