American Journal of Epidemiology Advance Access originally published
online on August 3, 2006
American Journal of Epidemiology 2006 164(9):890-897; Articles by
Langhammer, A.

What Is the Influence of Weight Change on Forearm Bone Mineral Density
in Peri- and Postmenopausal Women? The Health Study of Nord-Tr?ndelag,
Norway

Siri Forsmo1, J?rn Aaen2, Berit Schei1 and Arnulf Langhammer1
1 Department of Public Health and General Practice, Norwegian
University of Science and Technology, Trondheim, Norway
2 Faculty of Medicine, Norwegian University of Science and Technology,
Trondheim, Norway

Correspondence to Dr. Siri Forsmo, Department of Public Health and
General Practice, Medisinsk-teknisk senter, N-7489 Trondheim, Norway

Weight loss in the elderly increases bone loss and the risk of
fractures, especially at the hip and spine. The influence of weight
change on non-weight-bearing parts of the skeleton is less well known.
The purpose of this study was to investigate an association between
weight change during the peri- and postmenopausal years and forearm
bone mineral density (BMD). Among 8,856 women aged 45-60 years
attending the first Health Study of Nord-Tr?ndelag, Norway (HUNT I,
1984-1986), a random sample of 2,795 women was invited to forearm
densitometry (single x-ray absorptiometry technology) at HUNT II (1995-
1997), after a mean period of 11.3 years. A total of 2,005 women (mean
age: 65.1 years) were eligible. The mean weight had increased 3.4 kg;
the gain was greater in the youngest women. A total of 382 women
(19.1%) had lost and 1,331 women (66.3%) had gained weight. Weight
change explained little of the BMD variance, 0.7% and 0.4% for weight
loss and weight gain, respectively. Weight loss was an independent and
statistically significant negative predictor of BMD, adjusted for body
weight, age, age at menopause, smoking, and ovarian hormone treatment,
particularly among women with a baseline body mass index greater than
25 kg/m2. No independent association between weight gain and forearm
BMD was found.

*  *  *
http://www.***.com/

Weight loss is often associated with a decrease in BMD.  The change in
BMD seems to depend partly on whether the weight loss is caused by
calorie restriction or exercise.

Marilyn

The Journal of Clinical Endocrinology & Metabolism Vol. 92, No. 10
3809-3815
Copyright ? 2007 by The Endocrine Society

Effects of Weight Control during the Menopausal Transition on Bone
Mineral Density
Hyun A. Park, Jung S. Lee, Lewis H. Kuller and Jane A. Cauley
Seoul Paik Hospital (H.A.P.), College of Medicine, University of Inje,
Seoul 100-032, Korea; Department of Foods and Nutrition (J.S.L.),
University of Georgia, Athens, Georgia 30603; and Department of
Epidemiology (L.H.K., J.A.C.), Graduate School of Public Health,
University of Pittsburgh, Pittsburgh, Pennsylvania 15261

Address all correspondence to: Jane A. Cauley, Dr.P.H., University of
Pittsburgh, Department of Epidemiology, 130 DeSoto Street, A524
Crabtree Hall, Pittsburgh, Pennsylvania 15261. E-mail:

Background: Studies of weight loss and changes in bone mineral density
(BMD) have primarily been short-term trials in obese subjects.

Objective: We examined the effects of a 5-yr intervention designed to
prevent menopausal weight gain or promote modest weight loss on BMD in
premenopausal women participating in the Women's Healthy Lifestyle
Project.

Design: We enrolled 373 premenopausal women (age 44-50 yr) and
randomly assigned them to either lifestyle intervention (175 women,
low-fat dietary modification, weight loss, and physical activity
intervention) or control group (198 women). BMD and body weight were
measured at baseline, annual follow-up visits (18, 30, 42, and 54
months), and two postintervention follow-ups (66 and 78 months). BMD
was measured by dual x-ray absorptiometry.

Results: Over the 54 months of intervention, women in the intervention
group lost 0.4 kg, whereas control women gained 2.6 kg (P = 0.011).
The intervention group experienced significantly greater hip bone loss
(-0.20%/yr) than the control group (-0.03%/yr). During the
postintervention, differences in rates of bone loss disappeared. When
considering both menopausal status and use of hormone therapy (HT),
the annualized BMD changes were lower in women reporting HT use;
nevertheless, among women on HT, those who lost more than 3% body
weight experienced greater total hip BMD loss (-0.25%/yr) compared
with those who gained weight (-0.02%/yr) (P = 0.025).

Conclusions: Women randomized to a lifestyle intervention aimed at
preventing menopausal weight gain or promoting modest weight loss
experienced greater rates of hip bone loss than control women.

Marilyn, both studies show statistically significant bone mass reductions in
women who lose weight compared to women who gain weight. But the amounts of
bone mass loss from losing weight seem too small to have clinical
significance. It also seems to me, a non-expert in this area, that heavier
women are more likely to break a bone of the same size/density.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA

Actually, low BMI is a fracture risk factor.  In addition, losing
weight may occur not just once but many times (weight cycling).

Marilyn

The studies were fairly long term and thus would have included the
"weight-cycling" effect. Low BMI may well be a fracture risk factor, but
it's as much a measure of muscle mass as of weight.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA

When you lose weight, you usually lose muscle mass.  All I'm saying is
that weight loss is not necessarily an unmitigated good.  There are
risks and benefits, as with most medical interventions.  The risks and
benefits will vary for each person.

http://www.***.com/ (see table
1)

Marilyn

With dieting, yes.

With simply eating less of a regular diet, no.

VAT loss is good.

There is no risk and only benefit with VAT loss.

Not in the case of VAT loss.

Be hungry... be healthy... be hungrier... be blessed:

http://HeartMDPhD.com/PressRelease

Prayerfully in the infinite power and might of the Holy Spirit,

Andrew <><
--
Andrew B. Chung, MD/PhD
Lawful steward of http://EmoryCardiology.com
Bondservant to the KING of kings and LORD of lords.

In the context of the two studies cited, that's not clear.

A BMI less than 20 probably includes a lot of ill women. And it would
include no women who exercised regularly and included resistance training.

Weight loss is certainly not an unmitigated good. It can occur from many
chronic diseases. It can occur from unhealthy diets. It can even occur from
depression and excess sleep.

I doubt very much that weight loss due to an improved diet with restricted
amounts along with exercise sufficient to maintain muscle mass would
increase the risk of fractures.
--
Jim Chinnis   Warrenton, {*filter*}ia, USA

I agree.

Adequate calcium intake is effective in protecting from bone loss during
weight reduction.

http://www.medscape.com/viewarticle/554996

--
Juhana

http://ruohikolla.blogspot.com/

What is important is the effect on fractures.I expect weight loss with
adequate nutrition and increased activity would not  cause more
fractures in fact calcium plus vitamin d has been shown to reduce
fractures.

Calcium and vitamin D linked to cutting fractures

By Alex McNally

24/08/2007 - A new meta-analysis on calcium and vitamin D
supplementation in cutting osteoporotic fractures in people aged over
50 could quell concerns over conflicting outcomes of previous
studies.

Researchers writing in this week's The Lancet identified 29 randomised
trials featuring 63, 897 people over the age of 50, and found that
where people were sticking to a prescribed dose of the two, fraction
risk was reduced. ..........

.........Just last month a study in the American Journal of Clinical
Nutrition found supplementation with calcium and vitamin D could cut
bone loss in patients with recent osteoporotic fractures.

...........Although many studies have investigated the effect of
supplementation with calcium or calcium with vitamin D on fracture
risk in postmenopausal osteoporosis, there have been " conflicting
outcomes," according to Dr Jean-Yves Reginster, from the Bone and
Metabolism Unit, Liege, Brussels. Dr Reginster adds in the
accompanying comment that Dr Tang "provides clear answers to several
questions"  thrown up in previous studies.

The teams' meta-analysis found that treatment effect  in individuals
was better with calcium doses of 1200 mg or more, than with doses less
than 1200 mg, and with vitamin D doses of 800 IU or more, than with
doses less than 800 IU.

Lead author Dr Benjamin Tang, from the University of Sydney in
Australia, said: "Evidence supports the use of calcium, or calcium in
combination with vitamin D supplementation, in the preventive
treatment of osteoporosis in people aged 50 years or older. For best
therapeutic effect, we recommend minimum doses of 1200 mg of calcium,
and 800 IU of vitamin D (for combined calcium plus vitamin D
supplementation ."

The researchers found that supplementation is effective in the
preventive treatment of osteoporotic fractures by up to 24 per cent.
They added that over an average treatment duration of three to five
years, the risk of fracture was reduced and was accompanied by a
reduction of bone loss at the hip and spine.

The fracture risk reduction was greater in individuals who were
elderly, lived in institutions, had a low bodyweight, had a low
calcium intake, or were at a high baseline risk than it was in others,
they said.

The researchers also pointed out that on the basis of their
recommended minimum dose of 1200 mg of calcium or 800 IU of vitamin D,
many
formulations of calcium or combined calcium with vitamin D tablets
that are available contain insufficient quantities of the active
ingredients

They added that adequate dosage in supplements is an important issue
to be addressed in relation to good public health, as was the need for
individuals to comply with a prescribed level of a set course of time
to truly take advantages of these benefits.

Dr Tang said: "Poor compliance is a major obstacle to obtaining the
full benefit of calcium supplementation.......

Source: The Lancet
Vol 370 August 25, 2007
Use of calcium or calcium in combination with vitamin D
supplementation to prevent fractures and bone loss in
people aged 50 years and older: a meta-analysis
Authors: Benjamin Tang, Guy Eslick, Caryl Nowson, Caroline Smith, Alan
Bensoussan.

http://www.nutraingredients.com/news/ng.asp?id=79234-the-lancet-osteo...

Thanks Vince

Whether calcium and vitamin D reduces fracture risk or not was not the
issue I originally raised.  The issue was does weight loss cause a
decrease in BMD and/or increase in fracture risk.  The answer may
depend on a number of factors, including the population being studied
(age, gender, other risk factors), type of diet, whether the weight
loss is through exercise, calorie restriction, or some combination of
the two, and probably other factors that I am not aware of.  I doubt
all the answers are in yet on this.

Marilyn