Effect of weight loss on bone health in overweight/obese postmenopausal breast cancer survivors
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Current guidelines recommend weight loss in obese cancer survivors. Weight loss, however, has adverse effects on bone health in obese individuals without cancer but this has not been evaluated in breast cancer survivors. We investigated the associations of intentional weight loss with bone mineral density (BMD) and bone turn-over markers in overweight/obese postmenopausal breast cancer survivors. Participants were overweight/obese breast cancer survivors (N = 81) with stage I, II or IIIA disease enrolled in the St. Louis site of a multi-site Exercise and Nutrition to Enhance Recovery and Good health for You (ENERGY) study; a randomized-controlled clinical trial designed to achieve a sustained ≥7 % loss in body weight at 2 years. Weight loss was achieved through dietary modification with the addition of physical activity. Generalized estimating equations were used to assess differences in mean values between follow-up and baseline. Mean weight decreased by 3 and 2.3 % between baseline and 6-month follow-up, and 12-month follow-up, respectively. There were decreases in osteocalcin (10.6 %, p value < 0.001), PINP (14.5 %, p value < 0.001), NTx (19.2 % p value < 0.001), and RANK (48.5 %, p value < 0.001), but not BALP and CTX-1 levels between baseline and 12-month follow-up. No significant changes occurred in mean T-scores, pelvis and lumbar spine BMD between baseline and 12-month follow-up. A 2.3 % weight loss over 12 months among overweight/obese women with early-stage breast cancer does not appear to have deleterious effect on bone health, and might even have beneficial effect. These findings warrant confirmation, particularly among breast cancer survivors with a larger magnitude of weight loss.
KeywordsBreast cancer Bone health Obesity Weight loss Bone mineral density
Research reported in this publication was supported by grants R21CA161105 and CA148791 from the National Cancer Institute and the Washington University Institute of Clinical, Translational Sciences Grant UL1TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), and the Biostatistics Core at Siteman Cancer Center. The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. Adetunji T. Toriola is supported by the Washington University School of Medicine, Barnes-Jewish Hospital Foundation, Siteman Cancer Center and a Faculty Diversity Award. The authors would also like to recognize the women who participated in the sub-site project of the ENERGY trial.
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Conflict of interests
The authors declare that they have no conflict of interest.
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