Villareal Dennis T, Shah Krupa, Banks Marian R, Sinacore David R, Klein Samuel
Division of Geriatrics and Nutritional Science, Center for Human Nutrition, Washington University School of Medicine, 4488 Forest Park Boulevard, St. Louis, MO 63108, USA.
J Clin Endocrinol Metab. 2008 Jun;93(6):2181-7. doi: 10.1210/jc.2007-1473. Epub 2008 Mar 25.
Although weight loss and exercise ameliorates frailty and improves cardiac risk factors in obese older adults, the long-term effect of lifestyle intervention on bone metabolism and mass is unknown.
The objective was to evaluate the effects of diet-induced weight loss in conjunction with exercise on bone metabolism and mass in obese older adults.
We conducted a one-year randomized, controlled clinical trial in a university-based research center.
Twenty-seven frail, obese (body mass index = 39 +/- 5 kg/m(2)), older (age 70 +/- 5 yr) adults participated in the study.
Participants were randomly assigned to diet and exercise (treatment group; n = 17) or no therapy (control group; n = 10).
Body weight decreased in the treatment group but not in the control group (-10 +/- 2 vs. +1 +/- 1%, P < 0.001). Compared with the control group, the treatment group had greater changes in bone mass, bone markers, and hormones, including 1) bone mineral density (BMD) in total hip (0.1 +/- 2.1 vs. -2.4 +/- 2.5%), trochanter (0.2 +/- 3.3 vs. -3.3 +/- 3.1%), and intertrochanter (0.3 +/- 2.7 vs. -2.7 +/- .3.0%); 2) C-terminal telopeptide (12 +/- 35 vs. 101 +/- 79%) and osteocalcin (-5 +/- 15 vs. 66 +/- 61%); and 3) leptin (2 +/- 12 vs. -30 +/- 25%) and estradiol (0.1 +/- 14% vs. -14 +/- 21%) (all P < 0.05). Changes in weight (r = 0.55), bone markers (r = -0.54), and leptin (r = 0.61) correlated with changes in hip BMD (all P < 0.05).
Weight loss, even when combined with exercise, decreases hip BMD in obese older adults. It is not known whether the beneficial effects of weight loss and exercise on physical function lower the overall risk of falls and fractures, despite the decline in hip BMD.
尽管体重减轻和运动可改善肥胖老年人的虚弱状况并改善心脏危险因素，但生活方式干预对骨代谢和骨量的长期影响尚不清楚。
评估饮食诱导的体重减轻联合运动对肥胖老年人骨代谢和骨量的影响。
我们在一个大学研究中心进行了一项为期一年的随机对照临床试验。
27名身体虚弱、肥胖（体重指数=39±5kg/m²）、年龄较大（70±5岁）的成年人参与了该研究。
参与者被随机分配至饮食和运动组（治疗组；n=17）或不接受治疗组（对照组；n=10）。
治疗组体重下降，而对照组体重未下降（-10±2%对+1±1%，P<0.001）。与对照组相比，治疗组在骨量、骨标志物和激素方面有更大变化，包括：1）全髋部骨密度（BMD）（0.1±2.1%对-2.4±2.5%）、大转子（0.2±3.3%对-3.3±3.1%）和转子间（0.3±2.7%对-2.7±3.0%）；2）C端肽（12±35%对101±79%）和骨钙素（-5±15%对66±61%）；3）瘦素（2±12%对-30±25%）和雌二醇（0.1±14%对-14±21%）（所有P<0.05）。体重变化（r=0.55）、骨标志物变化（r=-0.54）和瘦素变化（r=0.61）与髋部BMD变化相关（所有P<0.05）。
体重减轻，即使与运动相结合，也会降低肥胖老年人的髋部BMD。尽管髋部BMD下降，但体重减轻和运动对身体功能的有益影响是否能降低跌倒和骨折的总体风险尚不清楚。
