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The Effect of Intentional Weight Loss on Fracture Risk in Persons With Diabetes: Results From the Look AHEAD Randomized Clinical Trial
Open accessAbstract
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. © 2017 American Society for Bone and Mineral Research.
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“However, 2017 data from the Look AHEAD trial showed that long-term intentional weight loss was associated with a 39% increased risk of fragility fractures325.”
From Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies (2018) · cites this paper as [325]
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“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, 1.89). [32]”
From New drugs for the treatment of obesity: do we need approaches to preserve muscle mass? (2025) · cites this paper as [32]
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“Reduced LBM may be of additional clinical importance given its association with decreased bone mineral density and increased risk of fractures, as well as its relation to metabolic function (e.g., insulin sensitivity) and aerobic capacity [72, 73].”
From The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities (2023) · cites this paper as [72]
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Goodpaster, B. H., Park, S. W., Harris, T. B., Kritchevsky, S. B., Nevitt, M., Schwartz, A. V., Simonsick, E. M., Tylavsky, F. A., Visser, M., Newman, A. B., et al. (2006) · The Journals of Gerontology Series A: Biological Sciences and Medical Sciences · doi:10.1093/gerona/61.10.1059 · Cited by 3,083 · cited 1×
“changes in body composition including a loss of lean body mass with a concomitant increase in fat mass.((28,29)) In the Look AHEAD DXA subgroup, lean body mass decreased more in the ILI than DSE between baseline and year 1 and remained lower through year 8.”
BackgroundSelf-citationCardiovascular effects of intensive lifestyle intervention in type 2 diabetes
The Look AHEAD Research Group (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1212914 · Cited by 2,908 · cited 1×
“However, despite these changes in lean body mass, the ILI group increased their physical activity resulting in improved fitness.(31) Further in the Look AHEAD trial, the weight loss and improved fitness have been shown to slow the decline in mobility in the ILI group compared to the DSE group.”
Dawson‐Hughes, B., Harris, S. S., Krall, E. A., & Dallal, G. E. (1997) · New England Journal of Medicine · doi:10.1056/nejm199709043371003 · Cited by 2,276
Kanis, J. А., Borgström, F., Laet, C. E. D. H. D., Johansson, H., Johnell, O., Jönsson, B., Odén, A., Zethraeus, N., Pfleger, B., & Khaltaev, N. (2004) · Osteoporosis International · doi:10.1007/s00198-004-1780-5 · Cited by 1,257
Prevention of falls and consequent injuries in elderly people
Kannus, P., Sievänen, H. T., Palvanen, M., Järvinen, T. L. N., & Parkkari, J. P. (2005) · The Lancet · doi:10.1016/s0140-6736(05)67604-0 · Cited by 1,128
Weight loss, exercise, or both and physical function in obese older adults
Villareal, D. T., Chode, S., Parimi, N., Sinacore, D. R., Hilton, T., Armamento-Villareal, R., Napoli, N., Qualls, C., & Shah, K. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1008234 · Cited by 1,096
Smoking and fracture risk: a meta-analysis
Kanis, J. A., Johnell, O., Oden, A., Johansson, H., De Laet, C., Eisman, J. A., Fujiwara, S., Kroger, H., McCloskey, E. V., Mellstrom, D., et al. (2005) · Osteoporosis International · doi:10.1007/s00198-004-1640-3 · Cited by 999
An estimate of the worldwide prevalence, mortality and disability associated with hip fracture
Johnell, O., & Kanis, J. A. (2004) · Osteoporosis International · doi:10.1007/s00198-004-1627-0 · Cited by 962
The Look AHEAD Study: A Description of the Lifestyle Intervention and the Evidence Supporting It
The Look AHEAD Research Group (2006) · Obesity · doi:10.1038/oby.2006.84 · Cited by 873
Mortality after osteoporotic fractures
Johnell, O., Kanis, J. А., Odén, A., Sernbo, I., Redlund-Johnell, I., Petterson, C., Laet, C. E. D. H. D., & Jönsson, B. (2003) · Osteoporosis International · doi:10.1007/s00198-003-1490-4 · Cited by 852
Hughes, V. A., Frontera, W. R., Roubenoff, R., Evans, W. J., & Singh, M. A. F. (2002) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/76.2.473 · Cited by 804
The Look AHEAD Research Group (2003) · Controlled Clinical Trials · doi:10.1016/s0197-2456(03)00064-3 · Cited by 767
FRAX® and its applications to clinical practice
Kanis, J. А., Odén, A., Johansson, H., Borgström, F., Ström, O., & McCloskey, E. V. (2009) · Bone · doi:10.1016/j.bone.2009.01.373 · Cited by 692
Alcohol intake as a risk factor for fracture
Kanis, J. А., Johansson, H., Johnell, O., Odén, A., Laet, C. E. D. H. D., Eisman, J. A., Pols, H. A. P., & Tenenhouse, A. (2004) · Osteoporosis International · doi:10.1007/s00198-004-1734-y · Cited by 629
Risk of fracture in women with type 2 diabetes: the Women's Health Initiative Observational Study.
Bonds, D., Larson, J. C., Schwartz, A., Strotmeyer, E., Robbins, J. A., Rodríguez, B., Johnson, K. C., & Margolis, K. (2006) · Journal of Clinical Endocrinology and Metabolism · doi:10.1210/jc.2006-0614 · Cited by 602
Self-citationOlder Women With Diabetes Have a Higher Risk of Falls
Schwartz, A. V., Hillier, T. A., Sellmeyer, D. E., Resnick, H. E., Gregg, E. W., Ensrud, K. E., Schreiner, P. J., Margolis, K. L., Cauley, J. A., Nevitt, M. C., et al. (2002) · Diabetes Care · doi:10.2337/diacare.25.10.1749 · Cited by 576
Self-citationRisk factors for hip fracture in european women: The MEDOS study
Johnell, O., Gullberg, B., Kanis, J. А., Allander, E., Elffors, L., Dequeker, J., Dilşen, G., Gennari, C., Vaz, L. A., Lyritis, G. P., et al. (1995) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.5650101125 · Cited by 562
Strotmeyer, E. S., Cauley, J. A., Schwartz, A. V., Nevitt, M. C., Resnick, H. E., Bauer, D. C., Tylavsky, F. A., de Rekeneire, N., Harris, T. B., & Newman, A. B. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.14.1612 · Cited by 373
Self-citationIntentional and Unintentional Weight Loss Increase Bone Loss and Hip Fracture Risk in Older Women
Ensrud, K. E., Ewing, S. K., Stone, K. L., Cauley, J. A., Bowman, P. J., Cummings, S. R., & for the Study of Osteoporotic Fractures Research Group (2003) · Journal of the American Geriatrics Society · doi:10.1046/j.1532-5415.2003.51558.x · Cited by 336
Lifestyle change and mobility in obese adults with type 2 diabetes
Rejeski, W. J., Ip, E. H., Bertoni, A. G., Bray, G. A., Evans, G., Gregg, E. W., & Zhang, Q. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1110294 · Cited by 301 · cited 1×
“Further in the Look AHEAD trial, the weight loss and improved fitness have been shown to slow the decline in mobility in the ILI group compared to the DSE group.((31))”
ResultSelf-citationMarques, E. A., Mota, J. A. P. S., & Carvalho, J. (2011) · AGE · doi:10.1007/s11357-011-9311-8 · Cited by 254
Impact of Hip and Vertebral Fractures on Quality-Adjusted Life Years
Tosteson, A. N. A., Gabriel, S. E., Grove, M. R., Moncur, M. M., Kneeland, T. S., & Melton, L. J. (2001) · Osteoporosis International · doi:10.1007/s001980170015 · Cited by 240
Kröger, H., Tuppurainen, M., Honkanen, R., ALHAVA, E. M., & Saarikoski, S. (1994) · Calcified Tissue International · doi:10.1007/bf00310160 · Cited by 226
Jensen, L. B., Kollerup, G., QUAADE, F., & Sørensen, O. H. (2001) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.2001.16.1.141 · Cited by 201
Weight Change and Fractures in Older Women
Ensrud, K. E. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.1997.00440290041004 · Cited by 189
Predictors of Non-Spine Fracture in Elderly Men: The MrOS Study
Lewis, C. E., Ewing, S. K., Taylor, B. C., Shikany, J. M., Fink, H. A., Ensrud, K. E., Barrett-Connor, E. L., Cummings, S. R., & ORWOLL, E. S. (2006) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.061017 · Cited by 175
Self-citationOverweight Postmenopausal Women Lose Bone With Moderate Weight Reduction and 1 g/day Calcium Intake
Riedt, C. S., Cifuentes, M., Stahl, T. J., Chowdhury, H. A., Schlussel, Y., & Shapses, S. A. (2005) · Journal of Bone and Mineral Research · doi:10.1359/jbmr.041132 · Cited by 174
Bray, G. A. (2006) · Diabetes and Vascular Disease Research · doi:10.3132/dvdr.2006.031 · Cited by 158
Self-citationKanis, J. А., Johansson, H., Odén, A., & McCloskey, E. V. (2009) · European Journal of Radiology · doi:10.1016/j.ejrad.2008.04.061 · Cited by 146
Look AHEAD Study Group, Jakicic, J. M., Jaramillo, S. A., Balasubramanyam, A., Bancroft, B., Curtis, J. M., Mathews, A., Pereira, M., Regensteiner, J. G., & Ribisl, P. M. (2009) · International Journal of Obesity · doi:10.1038/ijo.2008.280 · Cited by 145
Self-citationWeight change and fractures in older women. Study of Osteoporotic Fractures Research Group
Ensrud, K. E. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.157.8.857 · Cited by 144
Schwartz, A. V. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi023 · Cited by 142
Self-citationLanglois, J. A., Mussolino, M. E., Visser, M., Looker, A. C., Harris, T. B., & Madans, J. H. (2001) · Osteoporosis International · doi:10.1007/s001980170053 · Cited by 130
Diabetes Mellitus as a Risk Factor for Hip Fracture in Mexican American Older Adults
Ottenbacher, K. J., Ostir, G. V., Peek, M. K., Goodwin, J. S., & Markides, K. S. (2002) · The Journals of Gerontology Series A · doi:10.1093/gerona/57.10.m648 · Cited by 120
Pownall, H. J., Bray, G. A., Wagenknecht, L. E., Walkup, M. P., Heshka, S., Hubbard, V. S., Hill, J., Kahn, S. E., Nathan, D. M., Schwartz, A. V., et al. (2015) · Obesity · doi:10.1002/oby.21005 · Cited by 94
Self-citationSchwartz, A. V., Johnson, K., Kahn, S. E., Shepherd, J., Nevitt, M. C., Peters, A. L., Walkup, M. P., Hodges, A., Williams, C. C., & Bray, G. A. (2011) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.1483 · Cited by 91
Self-citationVoluntary weight loss: systematic review of early phase body composition changes
Heymsfield, S. B., Thomas, D., Nguyen, A. M., Peng, J. Z., Martin, C., Shen, W., Strauss, B., Bosy‐Westphal, A., & Muller, M. J. (2011) · Obesity Reviews · doi:10.1111/j.1467-789x.2010.00767.x · Cited by 88
Risk Factors for Ankle Fracture
Greenfield, D., & Eastell, R. (2001) · Osteoporosis International · doi:10.1007/s001980170140 · Cited by 85
The Look AHEAD Trial: Bone Loss at 4-Year Follow-up in Type 2 Diabetes
Lipkin, E. W., Schwartz, A. V., Anderson, A., Davis, C., Johnson, K., Gregg, E. W., Bray, G. A., Berkowitz, R. I., Peters, A. L., Hodges, A., et al. (2014) · Diabetes Care · doi:10.2337/dc14-0762 · Cited by 56
Self-citationEndogenous sex steroids, weight change and rates of hip bone loss in older men: the MrOS study
Ensrud, K. E., Lewis, C. E., Lambert, L. C., Taylor, B. C., Fink, H. A., Barrett-Connor, E. L., Cauley, J. A., Stefanick, M. L., & ORWOLL, E. S. (2006) · Osteoporosis International · doi:10.1007/s00198-006-0088-z · Cited by 45
Self-citationBrancati, F. L., Evans, M., Furberg, C. D., Geller, N., Haffner, S., Kahn, S. E., Kaufmann, P. G., Lewis, C. E., Nathan, D. M., Pitt, B., et al. (2012) · Clinical Trials · doi:10.1177/1740774511432726 · Cited by 34
Self-citationSevere hypoglycemia in the Look AHEAD Trial
Greenway, F. L. (2016) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2016.03.016 · Cited by 13
Self-citationStrotmeyer, E. S. (2008) · PubMed · Cited by 3
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Metadata
- Authors
- Johnson, K. C., Bray, G. A., Cheskin, L. J., Clark, J. M., Egan, C. M., Foreyt, J. P., Garcia, K. R., Glasser, S., Greenway, F. L., Gregg, E. W., Hazuda, H. P., Hergenroeder, A., Hill, J. O., Horton, E. S., Jakicic, J. M., Jeffery, R. W., Kahn, S. E., Knowler, W. C., Lewis, C. E., Miller, M., Montez, M. G., Nathan, D. M., Patricio, J. L., Peters, A. L., Pi-Sunyer, X., Pownall, H. J., Reboussin, D., Redmon, J. B., Steinberg, H., Wadden, T. A., Wagenknecht, L. E., Wing, R. R., Womack, C. R., Yanovski, S. Z., Zhang, P., Schwartz, A. V., & for the Look AHEAD Study Group
- Affiliations
- University of Tennessee Health Science Center (US)
- Pennington Biomedical Research Center (US)
- Johns Hopkins University (US)
- Weight Control and Diabetes Research CenterProvidenceRIUSA
- Baylor College of Medicine (US)
- Wake Forest University Health Sciences (US)
- University of Alabama (US)
- Centers for Disease Control and Prevention (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of Pittsburgh (US)
- University of Colorado Anschutz (US)
- Joslin Diabetes Center (US)
- University of Minnesota (US)
- University of Washington (US)
- Southwestern American Indian CenterPhoenixAZUSA
- Harvard University (US)
- St. Luke's-Roosevelt Hospital Center (US)
- University of Southern California (US)
- Columbia University Medical CenterNew YorkNYUSA
- Houston Methodist (US)
- University of Pennsylvania (US)
- Brown University (US)
- National Institutes of Health (US)
- Centers for Disease Control and PreventionAtlantaGAUSA
- University of California, San Francisco (US)
- Corresponding author
- Johnson, Karen C
- ORCID
- Johnson, Karen C
- Bray, George A
- Cheskin, Lawrence J
- Clark, Jeanne M
- Glasser, Stephen
- Greenway, Frank L
- Gregg, Edward W
- Hazuda, Helen P
- Hergenroeder, Andrea
- Hill, James O
- Horton, Edward S
- Jakicic, John M
- Kahn, Steven E
- Knowler, William C
- Lewis, Cora E
- Peters, Anne L
- Pownall, Henry J
- Reboussin, David
- Redmon, J Bruce
- Wadden, Thomas A
- Wagenknecht, Lynne E
- Wing, Rena R
- Schwartz, Ann V
- Venue
- Journal of Bone and Mineral Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-07-05
- Volume
- 32
- Issue
- 11
- Pages
- 2278-2287
- ISSN
- 0884-0431 (ISSN-L)
- 1523-4681
- PMC
- PMC5685890
- OpenAlex
- W2727111851
- Cited by
- 104
- References
- 43
- Citations by year
- 2026: 12 · 2025: 23 · 2024: 12 · 2023: 10 · 2022: 9 · 2021: 12 · 2020: 7 · 2019: 10 · 2018: 9
- FWCI
- 7.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Journal of Bone and Mineral Research (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Foundation for the National Institutes of Health (DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, DK 046204)
- National Heart, Lung, and Blood Institute
- National Center on Minority Health and Health Disparities
- Office of Research on Women's Health
- Centers for Disease Control and Prevention
- National Institute of Diabetes and Digestive and Kidney Diseases
- Johns Hopkins Medical Institutions Bayview General Clinical Research Center (M01RR02719)
- Massachusetts General Hospital (M01RR01066)
- Harvard Catalyst (RR025758-04)
- University of Colorado (M01RR00051)
- Clinical Nutrition Research Unit (P30 DK48520)
- University of Tennessee (M01RR0021140)
- University of Pittsburgh (M01RR000056)
- Clinical Translational Research Center (CTRC) funded by the Clinical & Translational Science Award (UL1 RR 024153)
- U.S. Department of Veterans Affairs (M01RR01346)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- intentional weight loss, fracture risk, type 2 diabetes, intensive lifestyle intervention, diabetes support and education, hip fracture, obesity, overweight, Look AHEAD trial, bone preservation, fracture prevention
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Risk Factors, Weight Loss, Incidence, Proportional Hazards Models, Fractures, Bone
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