Bone mineral density during reduction, maintenance and regain of body weight in premenopausal, obese women

Weight loss may lead to bone loss but little is known about changes in bone mass during regain of reduced weight. We studied changes in bone mineral density (BMD) and bone mineral content (BMC) during voluntary weight reduction and partial regain. The study consisted of three phases: a 3 month weight reduction with very-low-energy diet (VLED), a 9 month randomized, controlled walking intervention period with two training groups (target energy expenditure 4.2 or 8.4 MJ/ week) and a 24-month follow-up. The participants were premenopausal women with a mean body mass index of 34.0 (SD 3.6) kg/m(2). Seventy-four of 85 subjects completed the whole study. Total body, lumbar spine, proximal femur and dominant radius BMD and BMC were measured with dual-energy X-ray absorptiometry (DXA). The mean weight loss during VLED was 13.2 (3.4) kg, accompanied by unchanged total body BMC and decreased lumbar, trochanteric and radial BMD (p < 0.05). During months 3-36, an average of 62% of the weight loss was regained, total body BMC decreased and trochanteric BMD increased (p < 0.05). At the end of the study, total body BMC and lumbar and femoral neck BMD were lower than initially (p < 0.05). Weight change throughout the study correlated significantly with the change in radial (r = 0.54), total body (r = 0.39) and trochanteric (r = 0.37) BMD. Exercise-group assignment had no effect on BMD at weight-bearing sites. In conclusion, the observed changes in BMD and BMC during weight reduction and its partial regain were clinically small and partly reversible. More studies are needed to clarify whether the observed weight changes in BMD and BMC are real or are artifacts arising from assumptions, inaccuracies and technical limitations of DXA.