Diet plus physical activity mitigates weight loss-related decline in BMD in older women

In older women with metabolic syndrome, a lifestyle intervention based on energy-reduced Mediterranean diet plus physical activity lifestyle appears to mitigate the effects of weight loss on bone mineral density (BMD), according to the results of the 3-year, parallel-group PREDIMED-Plus trial.

The trial included 924 adults between 55 and 75 years (mean age 65.1 years, 50.9 percent male) who had metabolic syndrome and overweight or obesity, as well as access to dual-energy x-ray absorptiometry (DXA). These participants were randomly allocated to the intervention group (n=460) or the control group (n=464). The intervention consisted of an energy-reduced Mediterranean diet and increased physical activity, whereas the control involved an ad libitum Mediterranean diet with no physical activity promotion.

BMD (total femur, lumbar spine [L1-L4], and femoral trochanter) and total bone mineral content (BMC) were measured using DXA at baseline and at 1 and 3 years of follow-up. BMD variables were used to establish T-scores, with osteopenia or osteoporosis status defined as low BMD.

Compared with the control group, the intervention group showed greater increases in lumbar spine (L1-L4) BMD (between-group differences, −0.1 g/cm², 95 percent confidence interval [CI], –0.8 to 0.8 after 1 year and 0.9 g/cm², 95 percent CI, 0.1–1.8 after 3 years; p=0.05).

This association between the intervention and BMD gains was observed only among women (between-group differences, −0.1 g/cm², 95 percent CI, –1.3 to 1.1 after 1 year and 1.8 g/cm², 95 percent CI, 0.6–2.9 after 3 years; p=0.005) but not men. No overall 3-year intervention effect on total BMC and low BMD prevalence was observed.