Beavers Kristen M, Lynch S Delanie, Fanning Jason, Howard Marjorie, Lawrence Erica, Lenchik Leon, Shapses Sue A, Weaver Ashley A, Wherry Sarah J, Zamora Zeke, Nicklas Barbara J, Beavers Daniel P
Department of Internal Medicine, Section of Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina.
JAMA Netw Open. 2025 Jun 2;8(6):e2516772. doi: 10.1001/jamanetworkopen.2025.16772.
Weight loss (WL) in older adults is associated with bone loss, increasing the risk of fracture. Because skeletal tissue is responsive to mechanical stress, replacing lost weight externally may be an innovative way to minimize WL-associated bone loss in this population.
To examine the effect of 12 months of weighted vest use during WL on indicators of bone health compared with WL alone and WL plus resistance training (RT).
DESIGN, SETTING, AND PARTICIPANTS: This single-blind, 12-month randomized clinical trial of older adults living with obesity was conducted at an academic medical center from September 1, 2019, to April 30, 2024.
WL (caloric restriction targeting 10% WL with adequate calcium, vitamin D, and protein), WL plus weighted vest (WL+VEST; 8 h/d, weight replacement titrated up to 10% total WL), or WL plus progressive RT (WL+RT; supervised 3 sessions weekly).
Main outcomes included 12-month change in computed tomography-acquired trabecular volumetric bone mineral density (vBMD) and dual-energy X-ray absorptiometry-acquired areal bone mineral density (aBMD) of the total hip. Secondary outcomes included change in additional computed tomography- and dual-energy X-ray absorptiometry-acquired measures of musculoskeletal health and bone turnover biomarkers.
A total of 150 older (mean [SD] age, 66.4 [4.6] years) adults (112 [74.7%] women) living with obesity (mean [SD] body mass index, 33.6 [3.3]) were randomized (50 to WL, 50 to WL+VEST, and 50 to WL+RT), with 133 (88.7%) completing the trial. Similar significant WL, ranging from 9.0% to 11.2%, was achieved in all groups. During 12 months, mean (SD) self-reported weighted vest wear time was 7.1 (1.5) h/d, with 78.0% (29.9%) of lost weight replaced in the vest; participants randomized to the WL+RT group attended a mean (SD) of 71.4% (19.1%) of sessions. A significant decrease in total hip trabecular vBMD was observed at 12 months in all treatment groups (ranging from -1.2% to -1.9%), with no difference between the WL+VEST and WL groups (estimated treatment difference, +0.91 mg/cm3; 97.5% CI, -0.27 to 2.09 mg/cm3; P = .13) and noninferiority of WL+VEST compared with WL+RT (estimated treatment difference, +0.29 mg/cm3; 98.75% lower bound, -1.05 mg/cm3). Similar effects were observed for total hip aBMD.
In this 12-month randomized clinical trial, neither weighted vest use nor progressive RT was able to mitigate WL-associated bone loss at the hip in older adults living with obesity. This study highlights the need for alternative or adjunctive strategies to prevent bone loss in older adults experiencing WL because exercise may be insufficient on its own.
ClinicalTrials.gov Identifier: NCT04076618.
老年人体重减轻与骨质流失相关，会增加骨折风险。由于骨骼组织对机械应力有反应，外部补充体重减轻的部分可能是一种创新方法，可将该人群中与体重减轻相关的骨质流失降至最低。
与单纯体重减轻以及体重减轻加阻力训练（RT）相比，研究体重减轻期间使用12个月加权背心对骨骼健康指标的影响。
设计、地点和参与者：这项针对肥胖老年人的单盲、为期12个月的随机临床试验于2019年9月1日至2024年4月30日在一家学术医疗中心进行。
体重减轻（热量限制目标为体重减轻10%，同时补充足够的钙、维生素D和蛋白质），体重减轻加加权背心（WL+VEST；每天8小时，补充体重的比例逐渐增加至体重减轻总量的10%），或体重减轻加渐进式RT（WL+RT；每周监督3次训练）。
主要结局包括通过计算机断层扫描获得的全髋部小梁骨体积骨密度（vBMD）和通过双能X线吸收法获得的全髋部面积骨密度（aBMD）在12个月内的变化。次要结局包括通过计算机断层扫描和双能X线吸收法获得的肌肉骨骼健康和骨转换生物标志物的其他测量指标的变化。
共有150名肥胖老年人（平均[标准差]年龄为66.4[4.6]岁）（112名[74.7%]为女性）（平均[标准差]体重指数为33.6[3.3]）被随机分组（50名分到体重减轻组，50名分到体重减轻加加权背心组，50名分到体重减轻加渐进式RT组），其中133名（88.7%）完成了试验。所有组均实现了相似的显著体重减轻，范围在9.0%至11.2%之间。在12个月期间，自我报告的加权背心平均（标准差）穿着时间为7.1（1.5）小时/天，背心补充了78.0%（29.9%）减轻的体重；随机分配到WL+RT组的参与者平均（标准差）参加了71.4%（19.
