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Title: Effect of 1 year of an intentional weight loss intervention on bone mineral density in type 2 diabetes: Results from the Look AHEAD randomized trial

Author
item SCHWARTZ, ANN - University Of California
item JOHNSON, KAREN - University Of Tennessee
item KAHN, STEVEN - Veterans Administration, Puget Sound Health Care System
item SHEPHERD, JOHN - University Of California
item NEVITT, MICHAEL - University Of California
item PETERS, ANNE - University Of Southern California
item WALKUP, MICHAEL - Wake Forest University
item HODGES, AMELIA - Wake Forest University
item WILLIAMS, CARRIE - Wake Forest University
item BRAY, GEORGE - Louisana State University
item FOREYT, JOHN - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Bone and Mineral Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/17/2011
Publication Date: 12/2/2011
Citation: Schwartz, A.V., Johnson, K.C., Kahn, S.E., Shepherd, J.A., Nevitt, M.C., Peters, A.L., Walkup, M.P., Hodges, A., Williams, C.C., Bray, G.A., Look AHEAD Research Group. 2011. Effect of 1 year of an intentional weight loss intervention on bone mineral density in type 2 diabetes: Results from the Look AHEAD randomized trial. Journal of Bone and Mineral Research. 27(3):619-627.

Interpretive Summary: Intentional weight loss programs and practices are a very important aspect of treatment for overweight and obese type 2 diabetic patients. While an effort to decrease weight and body fat in these patients is important, the effects of these programs on bone mineral density are still unknown. Using data from the Look AHEAD trial, this study looked to determine the impact that that intensive lifestyle weight loss intervention (ILI) programs had compared to traditional diabetes support and education (DSE) on changes in bone mineral density (BMD) over a 12 month period. After a year, the study found that weight loss was greater in ILI than in DSE groups as well as improved glycemic control and overall physical fitness for the ILI group. In the ILI group, bone loss was greater at the hip and femoral neck than those in the DSE group. However, changes in BMD at the lumber spine and the whole body did not differ between the two groups. Intensive lifestyle intervention programs were found to help overweight and obese, type 2 diabetics lose weight, control their blood glycemic levels, and improved their overall physical fitness. While there was a modest decrease in BMD in the hip bone of subjects, overall body bone density and health was greatly improved. These benefits seem to greatly outweigh the minimal decrease in hip bone density, although further research will need to be investigated to determine these BMD in populations at risk for hip fractures and bone density loses.

Technical Abstract: Intentional weight loss is an important component of treatment for overweight patients with type 2 diabetes, but the effects on bone density are not known. We used data from the Look AHEAD trial to determine the impact of an intensive lifestyle weight loss intervention (ILI) compared with diabetes support and education (DSE) on changes in bone mineral density (BMD) over 12 months. Overweight and obese adults with type 2 diabetes were randomly assigned to ILI or DSE. In a substudy of BMD conducted at 5 of 16 clinical centers, hip, spine, and whole body dual X-ray absorptiometry scans were obtained at baseline and 1-year later on 642 of 739 ILI and 632 of 740 DSE participants. At baseline, mean age was 58.4 years, and average body mass index was 35.2 kg/m(2). Total hip BMD T-score was <-2.5 in 1% and <-1.0 in 8%. At 1 year, weight loss was greater in ILI than DSE (-8.6% versus -0.7%), and glycemic control and fitness were also improved. Bone loss over 1 year was greater in ILI at the total hip (-1.4% versus -0.4%; p < 0.001) and femoral neck (-1.5% versus -0.8%; p = 0.009), but change in BMD for the lumbar spine and whole body did not differ between groups. In ILI, bone loss at the total hip was independently associated with weight loss in men and women and with poorer glycemic control in men, but was not associated with changes in fitness. One year of an intensive lifestyle intervention in adults with type 2 diabetes, resulting in weight loss, was associated with a modest increase in hip bone loss despite improved fitness and glycemic control.