Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, LA, USA.
J Bone Miner Res. 2017 Nov;32(11):2278-2287. doi: 10.1002/jbmr.3214. Epub 2017 Jul 28.
Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m . Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted. © 2017 American Society for Bone and Mineral Research.
有目的的减轻体重是超重 2 型糖尿病患者的重要治疗选择，但对长期骨折风险的影响尚不清楚。本研究的目的是评估长期有目的的减轻体重是否会增加超重或肥胖糖尿病患者的骨折风险。该研究是一项多中心、随机临床试验。招募工作于 2001 年 8 月开始，16 个学术中心的中位随访时间为 11.3 年。共招募了 5145 名年龄在 45 至 76 岁之间、患有糖尿病的患者，他们被随机分配到强化生活方式干预组（ILI）或糖尿病支持和教育干预组（DSE）。ILI 组通过减少热量摄入和增加体力活动来实现和维持体重减轻 7%以上，DSE 组则接受糖尿病支持和教育干预。通过自我报告，每 6 个月确定一次骨折事件，并通过对医疗记录的中心审查来确认。参与者的基线平均年龄为 59 岁，60%为女性，63%为白人，平均 BMI 为 36kg/m。干预期间（中位 9.6 年）体重减轻 6.0%在 ILI 组，3.5%在 DSE 组。共有 731 名参与者发生了确诊的骨折事件（DSE 组 358 例，ILI 组 373 例）。在 ILI 和 DSE 组之间，总骨折或髋部骨折发生率没有统计学差异。然而，与 DSE 组相比，ILI 组发生脆弱性骨折的风险显著增加了 39%（HR 1.39；95%CI，1.02 至 1.89）。在超重/肥胖的糖尿病成人中，长期有目的的体重减轻导致的强化生活方式干预与总体骨折风险增加无关，但可能与脆弱性骨折风险增加有关。当计划有目的的减轻体重时，应考虑骨保护和骨折预防。
