The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes

Results From the Look AHEAD Randomized Clinical Trial

for the Look AHEAD Study Group

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m2. Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted.

Original languageEnglish (US)
Pages (from-to)2278-2287
Number of pages10
JournalJournal of Bone and Mineral Research
Volume32
Issue number11
DOIs
StatePublished - Nov 1 2017

Fingerprint

Life Style
Weight Loss
Randomized Controlled Trials
Education
Diabetes Mellitus
Bone Fractures
Hip Fractures
Self Report
Type 2 Diabetes Mellitus
Medical Records
Exercise
Therapeutics

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine

Cite this

The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes : Results From the Look AHEAD Randomized Clinical Trial. / for the Look AHEAD Study Group.

In: Journal of Bone and Mineral Research, Vol. 32, No. 11, 01.11.2017, p. 2278-2287.

Research output: Contribution to journalArticle

@article{be8ee97603254f8190384ff094952761,
title = "The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes: Results From the Look AHEAD Randomized Clinical Trial",
abstract = "Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7{\%} weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60{\%} were women, 63{\%} were white, and the mean BMI was 36 kg/m2. Weight loss over the intervention period (median 9.6 years) was 6.0{\%} in ILI and 3.5{\%} in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39{\%} increased risk of a frailty fracture (HR 1.39; 95{\%} CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted.",
author = "{for the Look AHEAD Study Group} and Johnson, {Karen C.} and Bray, {George A.} and Karen Johnson and Clark, {Jeanne M.} and Egan, {Caitlin M.} and Foreyt, {John P.} and Garcia, {Katelyn R.} and Stephen Glasser and Greenway, {Frank L.} and Gregg, {Edward W.} and Hazuda, {Helen P.} and Andrea Hergenroeder and Hill, {James O.} and Horton, {Edward S.} and Jakicic, {John M.} and Jeffery, {Robert W.} and Kahn, {Steven E.} and Knowler, {William C.} and Lewis, {Cora E.} and Marsha Miller and Montez, {Maria G.} and Nathan, {David M.} and Patricio, {Jennifer L.} and Peters, {Anne L.} and Xavier Pi-Sunyer and Pownall, {Henry J.} and David Reboussin and Redmon, {J. Bruce} and Helmut Steinberg and Wadden, {Thomas A.} and Helmut Steinberg and Wing, {Rena R.} and Womack, {Catherine R.} and Yanovski, {Susan Z.} and Catherine Womack and Schwartz, {Ann V.}",
year = "2017",
month = "11",
day = "1",
doi = "10.1002/jbmr.3214",
language = "English (US)",
volume = "32",
pages = "2278--2287",
journal = "Journal of Bone and Mineral Research",
issn = "0884-0431",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes

T2 - Results From the Look AHEAD Randomized Clinical Trial

AU - for the Look AHEAD Study Group

AU - Johnson, Karen C.

AU - Bray, George A.

AU - Johnson, Karen

AU - Clark, Jeanne M.

AU - Egan, Caitlin M.

AU - Foreyt, John P.

AU - Garcia, Katelyn R.

AU - Glasser, Stephen

AU - Greenway, Frank L.

AU - Gregg, Edward W.

AU - Hazuda, Helen P.

AU - Hergenroeder, Andrea

AU - Hill, James O.

AU - Horton, Edward S.

AU - Jakicic, John M.

AU - Jeffery, Robert W.

AU - Kahn, Steven E.

AU - Knowler, William C.

AU - Lewis, Cora E.

AU - Miller, Marsha

AU - Montez, Maria G.

AU - Nathan, David M.

AU - Patricio, Jennifer L.

AU - Peters, Anne L.

AU - Pi-Sunyer, Xavier

AU - Pownall, Henry J.

AU - Reboussin, David

AU - Redmon, J. Bruce

AU - Steinberg, Helmut

AU - Wadden, Thomas A.

AU - Steinberg, Helmut

AU - Wing, Rena R.

AU - Womack, Catherine R.

AU - Yanovski, Susan Z.

AU - Womack, Catherine

AU - Schwartz, Ann V.

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m2. Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted.

AB - Intentional weight loss is an important treatment option for overweight persons with type 2 diabetes mellitus (DM), but the effects on long-term fracture risk are not known. The purpose of this Look AHEAD analysis was to evaluate whether long-term intentional weight loss would increase fracture risk in overweight or obese persons with DM. Look AHEAD is a multicenter, randomized clinical trial. Recruitment began in August 2001 and follow-up continued for a median of 11.3 years at 16 academic centers. A total of 5145 persons aged 45 to 76 years with DM were randomized to either an intensive lifestyle intervention (ILI) with reduced calorie consumption and increased physical activity designed to achieve and maintain ≥7% weight loss or to diabetes support and education intervention (DSE). Incident fractures were ascertained every 6 months by self-report and confirmed with central adjudication of medical records. The baseline mean age of participants was 59 years, 60% were women, 63% were white, and the mean BMI was 36 kg/m2. Weight loss over the intervention period (median 9.6 years) was 6.0% in ILI and 3.5% in DSE. A total of 731 participants had a confirmed incident fracture (358 in DSE versus 373 in ILI). There were no statistically significant differences in incident total or hip fracture rates between the ILI and DSE groups. However, compared to the DSE group, the ILI group had a statistically significant 39% increased risk of a frailty fracture (HR 1.39; 95% CI, 1.02 to 1.89). An intensive lifestyle intervention resulting in long-term weight loss in overweight/obese adults with DM was not associated with an overall increased risk of incident fracture but may be associated with an increased risk of frailty fracture. When intentional weight loss is planned, consideration of bone preservation and fracture prevention is warranted.

UR - http://www.scopus.com/inward/record.url?scp=85026412964&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026412964&partnerID=8YFLogxK

U2 - 10.1002/jbmr.3214

DO - 10.1002/jbmr.3214

M3 - Article

VL - 32

SP - 2278

EP - 2287

JO - Journal of Bone and Mineral Research

JF - Journal of Bone and Mineral Research

SN - 0884-0431

IS - 11

ER -