TOPLINE: 

Weight management and exercise in older adults with obesity preserved bone quality despite weight loss and reductions in bone mineral density.

METHODOLOGY:

• Researchers conducted a randomized controlled trial at the Baylor College of Medicine and the Michael E. DeBakey VA Medical Center in Houston to assess the effect of lifestyle intervention on bone quality in 120 older adults with obesity.
• Participants were randomly assigned to either an intensive lifestyle group (n = 60; mean age, 71.3 years; 48% women), which received a weight management and exercise intervention, or a healthy lifestyle group (n = 60; mean age, 71.5 years; 47% women), which entailed monthly educational sessions on healthy diets without external weight-loss programs.
• The intensive lifestyle group received a diet with a 500-750 kcal deficit per day and three times a week exercise training, supervised by qualified trainers. All participants were given supplements to help balance their calcium and vitamin D levels.
• The primary outcomes were the 12-month changes in the cortical thickness of the distal tibia and the bone strength of the hip, measured using high-resolution peripheral quantitative CT and finite element analysis of CT scans, respectively.
• Additional measures of bone quality included the microarchitecture and failure load of the radius and tibia, vertebral failure load, bone material strength, and trabecular bone score (used to assess trabecular architecture).

TAKEAWAY:

• No significant differences were found in the cortical thickness of the tibia at 12 months between the intensive and healthy lifestyle groups.
• Hip failure load changes were not significantly different between the groups; however, spine failure load increased in the intensive lifestyle group vs the healthy lifestyle group (between-group difference, -139; 95% CI, -229 to -48).
• At 12 months, the trabecular bone score increased by 3% in the intensive lifestyle group, and the bone material strength index rose by 5%. No changes were observed in the healthy lifestyle group.
• The intensive lifestyle group showed a 12% reduction in body weight, whereas the healthy lifestyle group had a 1% reduction. Total hip areal bone mineral density decreased by 2% in the intensive lifestyle group, with no change in the healthy lifestyle group. Exercise-related adverse events in the intensive lifestyle group included falls and pain in the neck, back, feet, or legs.

IN PRACTICE:

"These novel findings regarding the osteoprotective benefits of lifestyle changes have important clinical implications for preserving bone health during obesity treatment in older adults," the authors wrote. 

SOURCE:

This study was led by Giulia Gregori, MS, of the Division of Endocrinology, Diabetes, and Metabolism at the Baylor College of Medicine in Houston. It was published online on September 18, 2025, in The Lancet Healthy Longevity.

LIMITATIONS: 

The study had a small number of participants. The participants were volunteers who were physically fit to participate in a lifestyle program, which may limit the broader applicability of the results.

DISCLOSURES:

This study was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the US Department of Veterans Affairs and resources provided by the Michael E. DeBakey VA Medical Center. One author reported receiving consulting fees from the Biophytis Scientific Advisory Committee.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.