Sex differences in the effects of weight loss diets on bone mineral density and body composition: POUNDS LOST trial

Context: Weight loss is associated with reduction in bone mineral density (BMD). Objective: The objective was to address the role of changes in fat mass (FM) and lean mass (LM) in BMD decline in both sexes. Design: A 2-year randomized controlled trial, the Preventing Overweight Using Novel Dietary Strategies (POUNDS-LOST). Setting: The setting was the general community. Patients or Other Participants: Enrolled were 424 overweight and obese participants (mean age, 52 ± 9 y; 57% females). Intervention: Intervention included weight loss diets differing in fat, protein, and carbohydrates. Main Outcome Measures: Main outcome measures were change in spine, total hip (TH), and femoral neck (FN) BMD and sex differences after dietary intervention. Results: At baseline, a stronger correlation between BMD and body composition measurements was observed in women, primarily with LM (r = 0.419, 0.507, and 0.523 for spine, FN, and TH, respectively; all P < .001). In men, only LM correlated with hip BMD (r = 0.298; P < .001). Mean weight loss at 2 years was -6.9%, without differences among diets. Two-year changes in BMD were 0.005 (P = .04), -0.014 (P < .001), and -0.014 g/cm²(P = .001), at the spine, TH, and FN, respectively. These changes directly correlated with changes in LM in women (r = 0.200, 0.324, and 0.260 for spine, FN, and TH, respectively), whereas FM loss correlated only with changes in TH BMD (0.274; P < .001). In men, changes in LM (-0.323; P < .001) and FM (-0.213; P = .027) negatively correlated with changes in spine BMD. Conclusions: Weight loss diets result in sex-specific effects on BMD. Although men exhibited a paradoxical increase in spine BMD, women tended to decrease in BMD at all sites.