Kim Myung Jin, Kim Seonok, Jung Han Na, Jung Chang Hee, Lee Woo Je, Cho Yun Kyung
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Asan Diabetes Center, Asan Medical Center, Seoul, Korea.
J Obes Metab Syndr. 2025 Jan 30;34(1):41-53. doi: 10.7570/jomes24009. Epub 2025 Jan 13.
Although an appropriate weight management strategy is essential for obese individuals, weight loss can have adverse effects on bone mineral density (BMD). We conducted a systematic review of randomized controlled trials to evaluate changes in BMD after the implementation of various weight loss strategies.
The PubMed, Embase, Web of Science, and Cochrane Library databases were searched to find articles published from database inception until June 2023. Randomized controlled trials of various treatments for obese patients that reported changes in BMD were selected. The primary outcome was BMD of the whole body, lumbar spine, and total hip, measured using dual X-ray absorptiometry.
Eighteen randomized controlled trials involving 2,510 participants with obesity were included in the analysis. At follow-up examination, the BMD of the lumbar spine decreased significantly after metabolic surgery (mean difference [MD]=-0.40 g/cm; 95% confidence interval [CI], -0.73 to -0.07; I=0%); lifestyle and pharmacological interventions did not result in a significant decrease in BMD at any location. Metabolic surgery also produced the most substantial difference in weight, with an MD of -3.14 (95% CI, -3.82 to -2.47).
This meta-analysis is the first to examine the effects of all categories of anti-obesity strategies, including the use of anti-obesity medications, on BMD. Bariatric metabolic surgery can have adverse effects on BMD. Moreover, medications can be used as a treatment for weight loss without compromising bone quality.
尽管适当的体重管理策略对肥胖个体至关重要，但体重减轻可能会对骨矿物质密度（BMD）产生不利影响。我们对随机对照试验进行了系统评价，以评估实施各种减肥策略后骨矿物质密度的变化。
检索了PubMed、Embase、Web of Science和Cochrane图书馆数据库，以查找从数据库建立到2023年6月发表的文章。选择了报告骨矿物质密度变化的肥胖患者各种治疗方法的随机对照试验。主要结局是使用双能X线吸收法测量的全身、腰椎和全髋部的骨矿物质密度。
分析纳入了18项涉及2510名肥胖参与者的随机对照试验。在随访检查中，代谢手术后腰椎的骨矿物质密度显著下降（平均差值[MD]=-0.40g/cm²；95%置信区间[CI]，-0.73至-0.07；I²=0%）；生活方式和药物干预在任何部位均未导致骨矿物质密度显著下降。代谢手术在体重方面也产生了最大的差异，平均差值为-3.14（95%CI，-3.82至-2.47）。
这项荟萃分析首次研究了包括使用减肥药在内的所有类别抗肥胖策略对骨矿物质密度的影响。减肥代谢手术可能会对骨矿物质密度产生不利影响。此外，药物可用于减肥治疗而不影响骨质。
