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Protection of Bone Mass by Estrogens and Raloxifene during Exercise-Induced Weight Loss

Division of Geriatric Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262

Address all correspondence and requests for reprints to: Dr. Wendolyn S. Gozansky, 4200 East Ninth Avenue, Campus Box B179, Denver, Colorado 80262. E-mail: wendee.gozansky{at}UCHSC.edu.

The aim of this study was to determine whether estrogen and/or raloxifene help to conserve bone mineral density (BMD) during moderate weight loss. Postmenopausal women (n = 68) participated in a 6-month weight loss program that consisted primarily of supervised exercise training. Another 26 women were studied over 6 months of weight stability. All participants were randomized to three treatment arms: placebo, raloxifene (60 mg/d), or hormone therapy (HT; conjugated estrogens, 0.625 mg/d; trimonthly medroxyprogesterone acetate, 5 mg/d for 13 d, for women with a uterus). Changes in body weight (mean ± SE) averaged 0.8 ± 0.5 kg in the weight-stable group and –4.1 ± 0.4 kg in the weight loss group. Across all measured skeletal sites, average changes in BMD in weight stable women were –0.6 ± 1.1% (n = 7), 0.9 ± 0.6% (n = 9), and 3.0 ± 0.7% (n = 10) in the placebo, raloxifene, and HT groups, respectively; comparable BMD changes in the weight loss groups were –1.5 ± 0.5% (n = 22), –0.5 ± 0.5% (n = 23), and 1.1 ± 0.4% (n = 23). There were no significant interactions between weight loss and drug treatment on changes in BMD, but there were significant main effects of weight loss on lumbar spine (P = 0.022), total hip (P = 0.010), and trochanter BMD (P < 0.001). These findings suggest that weight loss, even when modest in magnitude and induced by exercise training, causes a reduction in BMD, particularly in women not taking raloxifene or HT. It is not known whether reductions in BMD of this magnitude increase the risk for osteoporotic fracture.

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