Does Bone Density Affect Weight?

Does Bone Density Affect Weight?

Despite evidence suggesting that energy deficit results in multiple metabolic and physiological benefits, physicians are usually unwilling to prescribe weight loss to people who are older or who suffer from lower bone mineral density (BMD) for fear that BMD is likely to decrease. It is unclear what the effect of weight loss is on bone health.

Bone density is more closely related to lean mass than the volume of body and weight. Although large or rapid weight loss is typically related to loss of bone density, slow or lesser weight loss is less likely to negatively impact BMD particularly when it’s accompanied by extreme resistance and/or training in loading. The maintenance of calcium intake and vitamin D intake is believed to positively impact BMD when weight loss is occurring. While the dual-energy X-ray absorptiometry is typically utilized to measure Bone density, it could overestimate BMD loss after huge weight loss. Volumetric quantitative computed imaging could be more precise in measuring changes in bone density after significant weight loss.

Does Bone Density Affect Weight?

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Introduction

The weight of a person’s body is directly linked to bone mineral densities (BMD). A lower BMI (BMI) has been recognized as a significant risk factor for a lower BMD and indicates a higher risk of loss of bone mass in the older years as well as in younger individuals who are not suffering from menses or eating disorders. However, an overweight body may be due to increased exercise or obesity and both can increase BMD however there is growing evidence to suggest that excess weight caused by obesity is harmful to bone and the risk of fracture. Furthermore, even though weight loss is suggested to lower the risk of comorbidities associated with being overweight, it can also cause loss of bone and increases the likelihood of fractures in older people. Exercise, diet, and certain medications can reduce bone loss as a result of weight loss. This article examines how weight gain due to increased adiposity and weight loss in isolation and together affect bone quality as well as bone turnover and loss of bone. The review also considers how treatments affect the rate of metabolism of bones during weight reduction.

Osteoporosis and obesity are growing problems across the world and both can be attributed to poor nutrition or excessive intake of calories or less physical exercise. A total of 1.5 billion individuals were obese in 2008 across the globe as well for the United States, 34% of the population is obese and 68% of them are overweight or overweight. This has resulted in an increase in the risk of co-morbidities, including heart disease (CVD) Type 2 Diabetes, and a variety of cancers. Osteoporosis is frequently referred to as a silent disorder which contrasts with the high profile of obesity. It is a major problem in the United States, osteoporosis affects 55% of those older than 50. One in three women will be affected by fractures, compared to one in five males however, the mortality following a fracture is higher for men. Obesity and osteoporosis are not thought to be part of normal aging. both diseases have similar hormonal changes and are linked to increased pro-inflammatory cytokines as well as oxidative stress. These causes contribute to an increase in fat accumulation and the loss the bone mass.

Bone Mineral Density

BMD (in grams/centimeter squared, transformed to milligrams/centimeter squared for these analyses) was measured at the distal forearm and ultra distal radius of the nondominant arm by three different single energy x-ray bone densitometers (DTX 100; Osteometer Meditech A/S, Copenhagen, Denmark). Every day calibration of the densitometers was carried out using phantoms that were specifically designed for the equipment. A cross-calibration experiment between the three instruments was conducted and didn’t reveal any significant distinctions. Each measurement site was manually monitored and adjusted. The process of densitometry, as well as quality assessment procedures, have been described in detail in the past.

Does Bone Density Affect Weight?

Body Composition and Bone

Lean and fat mass are two independent variables that determine bone mass. Lean mass is an indication of physical activity. Likewise, the adipose tissue functions as an endocrine organ that has significant effects on bone, as mentioned above. Premenopausal women have low muscle mass is related to lowering BMD  and the positive impact of higher body mass on bone happens only when the bone is comprised of lean mass. The excess weight of obesity is mostly due to excess adipose tissues, but generally, there is more fat-free soft tissue to help support the weight. The beneficial effect of having a higher mass of lean muscle on BMD could be due to lifestyle factors like eating and exercise, as well as estrogen sufficiency as well as genetic influences, or some combination of these. Furthermore, having a larger muscle mass can have an independent influence on better balance, which reduces frailty and fractures that are associated with osteoporotic fractures. The fat mass has an immediate correlation with bone-in certain studies of postmenopausal women, however, it is not always the case in young adults and children, and may vary based on the skeletal location and the amount of trabecular/cortical bone. In all cases, studies have adjusted the muscle mass which means the effect that fat has on bones may be established, which could explain the various conclusions of these studies. Furthermore, the place where fat is accumulated, which includes visceral adipose tissues (VAT) as opposed to subcutaneous tissues, could affect bone differently. For instance, studies of postmenopausal women indicate that there is a positive correlation between VAT and bone however, this is not the case for men or children however, the results may depend on the particular bone area that is being studied. However, a majority of these studies examine the amount of fat in the trunk using dual-energy x-ray absorptiometry (DXA) which includes visceral and subcutaneous depots, in contrast to the quantitative computed tomography (QCT) that can identify fat depots. A higher VAT is linked to more insulin resistance, dyslipidemia, and inflammatory cytokines. All of which are expected to affect bone. Yet, a decrease in VAT as a result of the loss of weight has proven to reduce BMD and suggests that other aspects that are not related to VAT may be regulating bone in restricting caloric intake (CR). In addition to white adipose tissue, the growth of bone marrow fat has been proven to be linked to lower BMD, and brown adipose tissue could be vital in keeping bone. Understanding how lean tissue, as well as the amount and type of adipose tissues, affect BMD in various populations is crucial to determine the risk of fractures in situations when body composition is changed.

Obesity and Bone

The pluripotent stromal cell can differentiate into mature types of cells, including adipocytes osteoblasts, and chondrocytes. Since the stromal cell can change into an osteoblast or an adipocyte, it can affect the ratio between adipose and bone tissue. This is also evident in a variety of medical conditions that reveal the relationship between bone marrow fat as well as BMD. Both osteoporosis as well as aging-related bone loss are linked with an increase in adipogenesis of the marrow and could indicate that stromal cells are being converted to adipocytes instead of osteoblasts. It’s not known if osteoblasts and adipocytes respond in a distinct and perhaps opposite way in response to the same factor controlling differentiation, which can ultimately impact the bone-fat relationship.

They include the thiazolidinedione family of antidiabetic medicines (i.e. Rosiglitazone, for instance) which increase the sensitivity of insulin and have been proven to increase adiposity and reduce bone mass and raise the risk of fracture. Another class of drugs that boost the amount of fat in the body, particularly visceral and at the cost of osteoblast differentiation are glucocorticoids. Furthermore, low-density lipoprotein oxidation substances cause osteoporotic bone loss by inducing progenitors’ marrow stromal cells to undergo adipogenic rather than osteogenic differentiation. In addition, skeletal loading caused by immobilization or lack of activity enhances the adipocyte’s differentiation and hinders osteoblast differentiation. There is evidence that the greater adiposity associated with being overweight is linked to a lower rate of bone growth. In the end, a deeper understanding of the cellular link between osteoblasts and adipocytes could lead to drugs that inhibit the adipogenesis in the bone marrow and reduce the age-loss of bone.

Bone Measurement Concerns: Obesity and Weight Loss

Weight reduction can also alter the accuracy of DXA due to modifications to the soft tissues surrounding the bone, however, it does not result in systematic errors in longitudinal results from DXA studies. Studies that simulate the growth of body fat via successive fat layering on bones demonstrate that this can overestimate BMD measurements using DXA. The general precision of DXA measurements in cases of extreme overweight (BMI >40 kg/m) is diminished studies that examine the extreme loss of weight (typically around 35 kg) following gastric bypass could be expected to underestimate the reduction in BMD. In addition, a decrease in BMD due to weight loss isn’t questioned due to evidence from animal models, and the greater chance of breaking, however, there are concerns about the accuracy and the inherent limitations in measuring bone due to the different quantities of extra soft tissue as time passes. This would, however, be a major factor in the meaning of studies that study the changes in bone structure following massive losses in weight or of thin individuals who are gaining weight due to the higher error for those who are at the highest levels in body mass. It is not as important to worry about measurement errors in studies that involve moderate weight loss or studies that have an uncontrolled group. Instruments like QCT and peripheral QCT or magnetic resonance images also decrease measurement error as they focus on bone quality and the position of fat. These should be considered in future studies.

Gender, Age, and Initial Body Weight

Loss of bone and an increased risk of fractures as a result of weight loss are common in men and women however neither of these has been observed in younger people. The lack of bone loss could result from the healthy maintenance of muscles in young and male women. In a six-month, controlled weight loss study 38 overweight (average age of 44 years, 35kg/m BMI) postmenopausal females shed 8percent of their weight, but without any significant BMD reduction. Since a lower body weight can lead to bone loss, a second study was conducted on obese premenopausal women (average age 38 years old; weight of 28, kg/m). In this study, 6 months of weight loss led to a 7% decrease in body weight but no decrease in BMD in any of the locations. Other studies have also shown that bone strength is maintained in younger women and men who consume adequate calcium during moderate weight loss, but bone isn’t spared in circumstances of severe weight reduction (see Bariatric Surgery and Extreme Weight Loss section below). In rodents, the biomechanical properties of bone are diminished in older as compared to younger, energy-restricted rodents. This is in line with the evidence of a greater fracture rate in older animals who lose weight.

Studies have shown that body weight isn’t just a factor in the decline in bone mass due to age however, weight loss can also lead to a greater decline in the bone of younger populations. In a massive study of overweight women who are older and losing weight (<=5 percent) than females (< 60 kg) lost more femoral neck BMD (3%/year) compared with heavier women (> 70 kg) who lost approximately 1%/year. There is evidence to suggest that the initial weight of a person leads to a greater loss of trabecular and cortical bone in rodent research. Different mechanisms could influence a differing response of bone to energy restrictions in obese as compared to leaner people, including the greater decrease in serum estrogen as well as other sex steroids.

Weight loss and obesity are linked to decreased cortical bone mass, and this combination could pose a risk to the cortical bone.

Weight Reduction and Bone

Weight loss of 10 percent will result in a significant improvement in the many comorbidities that are associated with weight gain. However, it can result in a 1% – 2percent loss of bone at the hip as well as throughout the body, and a 3% or 4% reduction in highly trabecular areas, such as the trochanter and the radius. Weight loss-induced BMD reduction was observed in postmenopausal women and men over the age of 50 and is nearly double the rate of annual bone loss among overweight people. Additionally, it’s not known if the rate or extent of weight loss affects reductions in the bone because during the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy (CALERIE) study, middle-aged people following a diet that was low in energy and quickly lost 15 percent of body weight didn’t show more bone loss than did those in the slower moderate weight loss treatment. Additionally, the long-term impact of weight loss persists in the form of a one-year study follow-up. Studies that are short-term (less than 6 months) studies of weight loss aren’t included in this review since bone remodeling needs a minimum of four to six months. It can last for anywhere from up to two years.

Numerous epidemiological studies have examined the effects of involuntary or voluntary weight reduction on the bone structure over a lengthy length. One study found that about 1,500 people were monitored for 30 years to evaluate the effects on bone after between 5% and 10 percent weight loss or gain. The rate of osteoporosis among the lowest quarter of the base BMI of 31% for people who lost weight, compared to 4 percent for individuals with weight gain. In a different study, males who lost more than 5% of their body weight experienced the highest risk of having 1.7 percent total hip BMD loss per year compared to 0.1 percent loss for men who were stable in their weight. A study of older women has identified risks for hip BMD loss over four years. The study found those who weigh more exhibit less BMD loss in Trochanter, the femoral neck, and hip total. Additionally, the high rate of BMD loss, as well as weight loss and fluctuation in weight, are factors that predict mortality due to all causes among women and older men.

Factors Leading to Bone Loss During Weight Loss

The hormones produced by adipocytes can contribute to bone metabolism in weight reduction. Leptin is an anorexic hormonal hormone that has both peripheral and central effects that hinder the formation of bone, possibly through the sympathetic pathway, as well as directly affecting osteoblasts and osteoclasts. The impact of lower levels of leptin’s effects on bone in clinical weight loss studies is likely to be complicated because of its diverse peripheral and central actions and the leptin resistance that is seen in obese individuals. Leptin, for instance, is not able to stop an increase in bone resorption and a reduction in bone formation due to weight loss among obese individuals, but it does increase BMD in women who suffer from amenorrhea. state of deficiency in energy. Adiponectin is an anti-inflammatory adipokine that is low in obese patients and rises when there is a 10 percent or more weight loss however its role in regulating bone mass isn’t understood. It could be that an increase in weight loss would result in a positive effect on bone mass. Other adipokines, such as visfatin and resistin that have been altered by weight loss don’t always correlate with BMD.

Calcium absorption as well as other factors influence the bone during CR A lack of energy can also decrease the effectiveness of calcium absorption and this is yet another way that weight loss can regulate the loss of bone. A number of the changes in the hormones caused by CR might also regulate the absorption of calcium. For instance, decreased estrogen levels and an increase in cortisol levels could harm calcium absorption. In line with these findings, the increased serum PTH which has been proven to occur in conjunction with weight loss may be an indication of reduced calcium absorption. Additionally, the decreased weight-bearing and loss of weight due to CR could cause loss of bone (see the section on exercise-induced weight loss). Insufficient intake of micronutrients in CR may be a factor in bone loss but is not a complete explanation since the replacement of micronutrients in clinical trials and rodent studies have also led to bone loss. The loss of mass due to weight loss would reduce the mechanical load on bone particularly when the loss was comprised of soft tissue that was lean along with adipose tissues.

In the end, the interactions between growth factors, hormones, and cytokines, as well as their impact on bone calcium absorption when you are under caloric restriction are a complex issue and dependent on other factors like body composition/weight as well as the weight loss and gender, age and ethnicity. An alteration of the profile of the hormone endocrine caused by restrictions on energy intake can impact bone directly as well as indirectly. The primary regulators or organs that react to energy restriction and affect calcium metabolism are methods to reduce or stop bone loss.

Potential Mechanisms for the influences of obesity and weight loss on bone

In the case of obesity, there is a myriad of factors that contribute to the increased bone mass, which includes the weight-bearing capacity of the excess soft tissue that covers the skeleton and the relationship of fat mass to the production of hormones that stimulate bone (i.e. leptin, estrogens, and Adiponectin) of the adipocyte and the production of bone-active hormones by other organs, such as in the stomach (i.e. Ghrelin, that stimulates growth hormone) as well as the pancreas (including amylin and insulin). In addition, obese individuals have lower levels of serum 25-hydroxycholecalciferol, which is attributed to its deposition in adipose tissue. Hyperparathyroidism in secondary form is seen in obese patients. In addition, the distribution of fats that influence hormone levels in the blood may alter the size of bones independently of obesity. In this case, visceral fat can be associated with increased bone mass as well as the levels of estrogen.

When weight loss is reduced it is observed a reduction in the circulating estrogen, as well as other hormones of sex, can be expected to boost osteoclastic activity either directly or indirectly through higher concentrations of cytokines. Additionally, there was an increase in the Ca-PTH axis the restriction of energy in women who consume normal or low Ca (0.6-1.0 grams/day) However, this was not the case for women whose Ca intake was very high (1.7 g/d) which could lead to an increase in the rate of bone loss. Though vitamin D intake tends to be diminished during moderate restriction of energy, however, a decrease in serum levels was not evident. Leptin and the adipocyte-derived hormones Adiponectin might also play a part in bone metabolism in weight loss. Leptin’s anorexic effects are not evident in obese individuals due to the resistance of leptin, however, levels decrease with weight reduction. Leptin’s primary effects hinder bone growth, while leptin directly affects osteoblasts, and indirectly impacts osteoclasts by triggering sympathetic signals. The relationship between bone and leptin in weight loss could be based on a variety of variables like gender, obesity and ethnicity, age, and leptin resistance. Adiponectin is generally reduced in people who are overweight and can increase in moderate weight loss. Since adiponectin decreases osteoclast numbers and promotes osteoblastogenesis is possible that an increase due to weight loss could be beneficial to bone mass. Additionally, the hormone that is derived from the gut, ghrelin, is also elevated in weight loss (to boost appetite) and can stimulate osteoblastic proliferation and differentiation. However, extreme weight loss through gastric bypass surgery lowers the serum ghrelin levels to undetectable levels which could result in a negative impact on bone.

Conclusion:

In the end, the findings suggest that loss of bone during the period of energy restriction for women postmenopausal and, possibly, in older men. The likelihood of bone loss is dependent on the body’s initial weight as well as gender, age as well as physical activity, and the conditions of diets like the degree of restriction on energy or the specific quantities of nutrient intake. The mechanisms that regulate bone caused by weight loss aren’t fully known at present. The groups that are most susceptible to losing bone due to weight loss benefit from greater Ca intake and/or perhaps greater levels of vitamin D intake, or other nutrients. However, we know that controlled studies that address the effects of other nutrients haven’t been conducted. The use of osteoporosis drugs for patients with a high risk of developing osteoporosis or when weight loss is severe could be a good idea. A personalized diet program designed to prevent bone loss is recommended for all individuals however, it is particularly recommended for those who are older than 50 years old.

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