title: The Look AHEAD Trial: bone loss at 4-year follow-up in type 2 diabetes.
abstract: OBJECTIVE
  To determine whether an intensive lifestyle intervention (ILI) designed to sustain weight loss and improve physical fitness in overweight or obese persons with type 2 diabetes was associated with bone loss after 4 years of follow-up.
  
  
  METHODS
  This randomized controlled trial of intensive weight loss compared an ILI with a diabetes support and education (DSE) group among 1,309 overweight or obese subjects. Bone mineral density was assessed at baseline and after 1 year and 4 years of intervention.
  
  
  RESULTS
  ILI was effective in producing significant weight loss (5.3% vs. 1.8% in ILI and DSE, respectively; P < 0.01) and increased fitness (6.4% vs. -0.8%) at year 4. In men, ILI participants had a greater rate of bone loss during the first year (-1.66% vs. -0.09% per year in ILI and DSE, respectively). Differences between groups were diminished by one-half after 4 years (-0.88% vs. -0.05% per year in ILI and DSE, respectively) but remained significant (P < 0.01). The difference in rate of hip bone loss between groups over 4 years was related to increased weight loss in ILI. Among women, the rate of bone loss did not differ between ILI and DSE after 4 years.
  
  
  CONCLUSIONS
  A 4-year weight loss intervention was significantly associated with a modest increase in bone loss at the hip in men but not in women.
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA ewl@u.washington.edu.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Lipkin
authors.affiliation: Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Anderson
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC.
authors.forename: Cralen
authors.initials: C
authors.lastname: Davis
authors.affiliation: Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Edward W
authors.initials: EW
authors.lastname: Gregg
authors.affiliation: Pennington Biomedical Research Center of Louisiana State University, Baton Rouge, LA.
authors.forename: George A
authors.initials: GA
authors.lastname: Bray
authors.affiliation: University of Pennsylvania School of Medicine, Philadelphia, PA.
authors.forename: Robert
authors.initials: R
authors.lastname: Berkowitz
authors.affiliation: Department of Medicine, Division of Endocrinology, Keck School of Medicine of University of Southern California, Los Angeles, CA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC.
authors.forename: Amelia
authors.initials: A
authors.lastname: Hodges
authors.affiliation: Department of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Cora
authors.initials: C
authors.lastname: Lewis
authors.affiliation: Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, VA Puget Sound Health Care System and University of Washington, Seattle, WA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Kahn
mesh_terms: D000368:Aged; D015519:Bone Density; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D050177:Overweight / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D010809:Physical Fitness; D011859:Radiography; D015431:Weight Loss / Q000502:physiology; D061217:Weight Reduction Programs