Weight Control and Bone Density During the Menopausal Transition

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Summary and Comment

Weight Control and Bone Density During the Menopausal Transition

A healthful diet and exercise program has a downside: loss in BMD.

Women typically gain weight during the menopausal transition, but do efforts to curb this weight gain affect bone-mineral density (BMD)? That question was addressed in a randomized trial involving 373 premenopausal white women (age range at study entry, 44–50).

Participants were assigned to a 5-year behavior modification program (low-fat diet, exercise, and weight-loss intervention) or to a control group. All participants were given a modest weight-loss goal based on baseline body-mass index; mean BMI was 25. In an assessment at 54 months, intervention participants had lost an average of 0.4 kg whereas controls had gained an average of 2.6 kg. During the study, total hip and femoral neck BMD (but not spine or total body BMD) decreased significantly in the intervention group compared with the control group after adjusting for age and baseline BMD. However, at a postintervention 12-month evaluation, the difference in BMD diminished as the difference in weight decreased. Hormone therapy also diminished BMD loss in postmenopausal women, but those who lost the most weight had greater reductions in BMD.

Comment: This intriguing study emphasizes how complicated health recommendations are: Maintaining or losing body weight during the menopausal transition may lead to reduced BMD. So what is the clinician to do? It seems unlikely that rational recommendations for a healthy lifestyle would be detrimental overall, as long as weight loss is not extreme among women who are of normal weight or only mildly overweight at the start of the transition. Moreover, it’s unclear whether the trends noted in this study would progress and translate into increased fracture rates later in life.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine October 30, 2007