Journal
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 32, Issue 11, Pages 2278-2287Publisher
WILEY
DOI: 10.1002/jbmr.3214
Keywords
FRACTURE; INTENTIONAL WEIGHT LOSS; TYPE 2 DIABETES; CLINICAL TRIAL
Categories
Funding
- NIH
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) [DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992]
- National Heart, Lung, and Blood Institute
- National Institute of Nursing Research
- National Center on Minority Health and Health Disparities
- NIH Office of Research on Women's Health
- Centers for Disease Control and Prevention
- Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases
- Johns Hopkins Medical Institutions Bayview General Clinical Research Center [M01RR02719]
- Massachusetts General Hospital Mallinckrodt General Clinical Research Center
- Massachusetts Institute of Technology General Clinical Research Center [M01RR01066]
- Harvard Clinical and Translational Science Center [RR025758-04]
- University of Colorado Health Sciences Center General Clinical Research Center [M01RR00051]
- Clinical Nutrition Research Unit [P30 DK48520]
- University of Tennessee at Memphis General Clinical Research Center [M01RR0021140]
- University of Pittsburgh General Clinical Research Center (GCRC) [M01RR000056]
- Clinical Translational Research Center (CTRC) - Clinical & Translational Science Award [UL1 RR 024153]
- Clinical Translational Research Center (CTRC) - NIH grant [DK 046204]
- VA Puget Sound Health Care System Medical Research Service, Department of Veterans Affairs
- Frederic C. Bartter General Clinical Research Center [M01RR01346]
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Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain >= 7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m(2). Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted. (C) 2017 American Society for Bone and Mineral Research.
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