Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology, and Immunology, Medical University of Vienna, Vienna, Austria.
Department of Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Hull, United Kingdom.
Gerontology. 2020;66(1):2-14. doi: 10.1159/000500779. Epub 2019 Jun 28.
In view of the existing uncertainty about the implications of intentional weight loss in older obese adults, the present review (a) summarizes the available evidence from epidemiological and interventional studies concerning the effects of weight loss through lifestyle modifications on skeletal health parameters in older overweight/obese individuals, (b) proposes mechanisms that link weight loss to bone loss in this age group, and (c) identifies appropriate animal models. Main Findings and Future Directions: Based on prospective epidemiological studies, weight loss is associated with bone loss, impaired bone macro- and microstructure, and increased fracture risk in the elderly. Data from interventional studies confirm the negative effects of intentional weight loss achieved by lifestyle modifications on skeletal health outcomes in obese older individuals. These effects appear to be modest following a single weight loss attempt, but may persist in the longer term, and presumably, during subsequent weight loss efforts. Current evidence suggests that resistance exercise coupled with caloric restriction mitigates bone and muscle loss. However, alternative strategies do not exist for older individuals, especially those who are unable or unwilling to exercise. Clinical weight loss studies in obese older individuals and preclinical research in relevant animal models with obesity and osteoporosis are required. These will advance our understanding of the pathophysiology of weight-loss-associated skeletal alterations and provide evidence on how bone loss can be counteracted or prevented.
鉴于目前对于老年肥胖人群中有意减轻体重的影响尚不确定，本综述（a）总结了来自流行病学和干预性研究的现有证据，这些研究涉及通过生活方式改变减轻体重对超重/肥胖老年人骨骼健康参数的影响，（b）提出了将体重减轻与该年龄段骨丢失联系起来的机制，以及（c）确定了合适的动物模型。主要发现和未来方向：基于前瞻性流行病学研究，体重减轻与老年人的骨丢失、骨宏观和微观结构受损以及骨折风险增加有关。干预性研究的数据证实了通过生活方式改变有意减轻体重对肥胖老年人骨骼健康结果的负面影响。这些影响在单次体重减轻尝试后似乎不大，但可能会持续更长时间，并且可能在随后的体重减轻努力中持续存在。目前的证据表明，阻力运动加热量限制可减轻骨和肌肉丢失。然而，对于老年人，尤其是那些无法或不愿意运动的人，目前还没有其他替代策略。需要在肥胖的老年人群中进行临床减重研究，并在相关的肥胖和骨质疏松症动物模型中进行临床前研究。这将有助于我们了解与体重减轻相关的骨骼改变的病理生理学，并提供有关如何对抗或预防骨丢失的证据。
