The Look AHEAD Trial: bone loss at 4-year follow-up in type 2 diabetes

Abstract

Objective: To determine whether an intensive lifestyle intervention (ILI) designed to sustain weight loss and improve physical fitness in overweight or obese persons with type 2 diabetes was associated with bone loss after 4 years of follow-up.

Research design and methods: This randomized controlled trial of intensive weight loss compared an ILI with a diabetes support and education (DSE) group among 1,309 overweight or obese subjects. Bone mineral density was assessed at baseline and after 1 year and 4 years of intervention.

Results: ILI was effective in producing significant weight loss (5.3% vs. 1.8% in ILI and DSE, respectively; P < 0.01) and increased fitness (6.4% vs. -0.8%) at year 4. In men, ILI participants had a greater rate of bone loss during the first year (-1.66% vs. -0.09% per year in ILI and DSE, respectively). Differences between groups were diminished by one-half after 4 years (-0.88% vs. -0.05% per year in ILI and DSE, respectively) but remained significant (P < 0.01). The difference in rate of hip bone loss between groups over 4 years was related to increased weight loss in ILI. Among women, the rate of bone loss did not differ between ILI and DSE after 4 years.

Conclusions: A 4-year weight loss intervention was significantly associated with a modest increase in bone loss at the hip in men but not in women.

Trial registration: ClinicalTrials.gov NCT00017953.

© 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

Figures

Figure 1

Mean percent change in BMD per year (± SEM) for the intervals of 0–1 year and 1–4 years of follow-up derived from repeated-measures (mixed) modeling of the relationship between time and change in BMD. The solid bars represent the ILI group, and the striped bars represent the DSE group. Adjusted for age, ethnicity, study center, insulin use, TZD use, menstrual status (for female models only), duration of diagnosed diabetes, BMI, proteinuria, and smoking status (all baseline values).