Structured Weight Loss Protects Lumbar and Hip Bone Density in Postmenopausal Women

Older women with overweight or obesity who followed a calorie-controlled Mediterranean diet combined with regular physical activity maintained key markers of bone health over three years. Bone mineral density at the spine and hip remained stable, even as participants lost weight. These are two regions most affected by age-related and hormonal bone loss. The intervention also prevented declines in total bone mineral content, which typically drops during caloric restriction. This approach offers a clinically relevant way to support skeletal health during weight loss in postmenopausal women.

Lumbar Spine BMD Preserved in Older Women During Caloric Restriction

For older women with excess weight and metabolic risk, a calorie-restricted Mediterranean diet paired with structured physical activity preserved bone mineral density (BMD) at the lumbar spine over three years. This region contains trabecular bone, which is sensitive to hormonal decline and age-related turnover. The preservation effect remained even in participants who were not taking calcium or vitamin D supplements.

Bone Density at the Hip Maintained Despite Weight Loss

Women following the intervention maintained BMD at the femur and upper thigh, regions commonly affected by osteoporotic fractures. These sites contain cortical bone, which often deteriorates during weight loss. Maintaining density in these locations is critical for preventing hip fractures in older adults.

Total Mineralized Bone Mass Did Not Decline During Intervention

The intervention preserved total bone mineral content (BMC), which measures the overall amount of mineral in the skeleton. This finding is important because calorie-restricted diets typically lead to reductions in BMC. Nutrient-dense eating and physical activity appeared to stabilize skeletal mass despite fat loss.

Women Showed Greater Bone Preservation Than Men

Female participants experienced stronger preservation of lumbar spine BMD compared to men. This supports the use of targeted interventions in postmenopausal women, who are especially vulnerable to trabecular bone loss due to estrogen decline. The intervention may offer a viable strategy for minimizing bone loss during intentional weight reduction.

Practical Guidelines: Bone Preservation During Weight Loss

• Recommend a Mediterranean dietary pattern that restricts calories without compromising protein or micronutrient intake, particularly calcium, magnesium, and vitamin K
• Incorporate at least 150 minutes per week of moderate weight-bearing physical activity, including walking and resistance training, to support bone remodeling
• Avoid low-protein or nutrient-poor hypocaloric diets that accelerate skeletal loss
• Assess baseline BMD prior to initiating weight loss plans in women over age 60
• Monitor for changes in lumbar and hip BMD in postmenopausal women at 12-month intervals during sustained caloric restriction

Further Reading:

• “Mediterranean Diet and Bone Health in Aging Women,”
• “Physical Activity and Bone Integrity in Older Adults,”

Reference: Marin-Alejandre BA, Martín-Calvo N, Basterra-Gortari FJ, et al. Effect of a Weight-Loss Lifestyle Intervention on Bone Mineral Density in Older Adults With Overweight and Obesity: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(7):e2323372. doi:10.1001/jamanetworkopen.2023.23372