Weight loss lifestyle alters slow bone loss in older adults

Weight loss lifestyle alters slow bone loss in older adults

A study shows that a calorie-restricted Mediterranean diet with physical activity preserves bone health in older adults with metabolic syndrome—particularly women—and holds promise for preventing age-related osteoporosis.

A current oneJama Network Open The study evaluates the effects of a weight loss intervention on age-related bone deterioration.

Aging and bone health

Aging is associated with low bone mineral density (BMD) and total bone mineral content (BMC), which increases the risk of osteoporotic fractures. As the world population continues to age, the prevalence of osteoporosis, which is associated with reduced quality of life and significant patient morbidity, has also increased. Therefore, it is crucial to identify behavioral interventions that can mitigate the impact of osteoporosis to reduce the burden of this disease on the global health sector.

A balanced diet and regular physical activity are effective strategies that have been shown to prevent osteoporotic fractures, particularly in vulnerable patient populations such as the elderly and obese. Because weight loss is often recommended to treat obesity-related conditions, it is important to determine the role of these strategies on bone health to aid in the development of more effective weight loss strategies with minimal impact on age-related bone deterioration.

Adhering to a healthy diet during the energy restriction phase of weight loss could help maintain adequate BMD and BMC. To date, several studies have reported the benefits of the Mediterranean diet on bone health regardless of an individual's age. However, few studies have analyzed the effect of energy-restricted diets designed for weight loss to treat obesity and osteoporotic risk.

About the study

The Prevención Con Dieta Mediterránea-Plus (Predimed-Plus) randomized clinical trial was carried out in 23 health centers in Spain. Here, researchers examined the effects of a multifactorial intervention on age-related BMD, total BMC, and low BMD prevalence in older adults with metabolic syndrome and overweight or obesity over three years of follow-up.

Various lifestyle-based interventions considered in this analysis included an energy-restricted Mediterranean diet, increased physical activity, and behavioral support.

Community-known adults between 55 and 75 years of age with at least three metabolic syndromes and were either overweight or obese were recruited for participation. Initially, 6,874 eligible participants were randomly assigned to either the control group or the intervention group, stratified by center, gender, and age in a 1:1 ratio.

The control group was recommended to follow a traditional Mediterranean diet without energy restrictions or specific physical activity recommendations. In comparison, the intervention group received specific recommendations for a Mediterranean diet with an energy reduction of 30%. The intervention cohort also received counseling to gradually increase their physical activity level to meet the recommended World Health Organization (WHO) criteria for adults aged 65 years and older.

In addition to physical activity and nutrition, study participants were subjected to behavioral and motivational strategies to facilitate sustained adoption of nutritional and lifestyle changes. Dual-energy X-ray absorptiometry (DXA) was also used to track BMD variables and total BMC at baseline, 1-year and 3-year follow-up.

Targeted lifestyle changes lead to stronger bones in older adults

A total of 924 individuals with metabolic syndrome and DXA scan data in the final study cohort. At baseline, 464 study participants were included in the control group and 460 in the intervention group, of which 49.1% were female with a mean age of 65.1 years.

Compared to controls, the intervention group experienced a greater reduction in total body weight of 3.3% and 3% over one and three years, respectively. A significant difference in total body changes was observed between the two groups at -2.8 kg and -2.2 kg after one and three years, respectively.

After adjusting for several covariate factors such as smoking status, age, gender, education level, and medical history, significant differences in mean changes were observed between groups.

For example, study participants in the intervention group showed an overall increase in lumbar spine BMD (L1-L4) compared to controls after three years. In addition, a protective association was established among women but not men.

The intention-to-treat analysis revealed that after three years, there was an increase in total femur, lumbar spine (L1-L4), and femoral trochanter BMD in women in the intervention group compared to controls. Likewise, the completist's case analysis showed that women in the intervention showed greater increases in lumbar spine (L1-L4) BMD compared to controls at three years.

The results of the sensitivity analysis were consistent with these findings. Notably, the overall three-year intervention effect was significant for total BMC in women compared to men.

Conclusions

A modest hypocaloric Mediterranean diet combined with physical activity had effects on bone health in older women with metabolic syndrome, particularly on lumbar effects, compared to recommendations for ad libitum Mediterranean diets.

Additional studies are needed to evaluate the effects of this weight loss intervention on bone health for longer follow-up periods. Nevertheless, the study results support the inclusion of this intervention in future public health strategies aimed at reducing the prevalence of osteoporotic fractures in older adults.

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