Weight loss and bone density

 Jennifer Morris, MD PC

ABPN, ABOM, ABPM-add, ABSPP

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Healthy weight management, including weight loss, may be beneficial to some health parameters. However,  weight loss without exercise may compromise other aspects of health.  One such area of compromise is bone density. Rapid/large weight loss has a higher association with loss of bone density. (Hunter) This may occur due to two primary causes:

1. decreased mechanical loading of bones during locomotion

2. reduced parathyroid hormone and extraovarian estrogen production

Additionally, weight loss via restriction contributes greater to bone mass loss than does exercise-mediated weight loss (some of this is negated if calcium intake is preserved and calcium deficiency prevented; vitamin D appears to also play an integral role in maintaining bone mineral density)

Resistance training has been demonstrated to reduce bone density loss associated with weight loss. Indeed, muscle mass is more strongly related to bone mineral density than is fat or body weight, and resistance training and/or high impact training may be associated with maintenance or increase in bone mineral density during weight loss. 

For those with challenges keeping up with resistance training over the long haul, weighted vests have been found to be beneficial. By replacing lost weight with vest weight load, the effect is keeping the skeleton loaded as excess body weight is lost, avoiding bone density loss that can increase fracture risk.  INVEST study. (Miller)

Hunter, Gary R, Eric P Plaisance, and Gordon Fisher. Weight Loss and Bone Mineral Density. Curr Opin Endocrinol Diabetes Obes, 2015 Oct 1.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4217506/#:~:text=Although%20rapid%2Flarge%20weight%20loss%20is%20often%20associated%20with,seems%20to%20positively%20affect%20BMD%20during%20weight%20loss. Accessed 9/8/24. 

Miller, Ryan M. , Daniel P Beavers, Peggy M Cawthon, Charlotte Crotts, Jason Fanning, James Gerosa, Katelyn A Green, Katherine L Hsieh, Jessica Kiel, Erica Lawrence, Leaon Lenchik, S. Delanie Lynch, Beverly A Nesbit, Barbara J Nicklas, Ashley A Weaver, Kristen M Beavers. Incorporating Nutrition, Vests, Education, and Strength Training (INVEST) in Bone Health: Trial Design and Methods. Contemp Clin Trials. 2021 May:104:106326. doi: 10.1016/j.cct.2012.106326. Epub 2021 Feb 22. https://pubmed.ncbi.nlm.nih.gov/33631359/. Accessed 9/8/24.