■体重减轻的主要问题是伴随的骨质流失。运动和胰高血糖素样肽-1受体激动剂(GLP-1RA)代表体重减轻策略,尽管体重减轻,但仍可以保护骨量。
■调查临床相关部位的骨骼健康状况(髋部,脊柱,和前臂)饮食引起的体重减轻后,再进行为期1年的运动干预,利拉鲁肽,或两者结合。
这项研究是对2016年8月至2019年11月在哥本哈根大学和丹麦Hvidovre医院进行的一项随机临床试验的预定义二次分析。符合条件的参与者包括18至65岁肥胖(体重指数为32-43)且无糖尿病的成年人。数据分析于2023年3月至4月进行,2024年2月在修订期间进行了额外分析。
■经过8周的低热量饮食(800千卡/天),参与者被随机分为4组,每组52周:中等强度至剧烈强度的运动计划(单独运动),每日3.0mgGLP-1RA利拉鲁肽(单用利拉鲁肽),组合,或安慰剂。
■主要结果是髋部特定部位骨密度(BMD)的变化,腰椎,从低热量饮食到治疗结束前的前臂远端,在意向治疗人群中通过双能X射线吸收法测量。
■总共,195名参与者(平均[SD]年龄,42.84[11.87]岁;124名女性[64%]和71名男性[36%];平均[SD]BMI,37.00[2.92])是随机的,运动组中有48名参与者,利拉鲁肽组的49名参与者,组合组49名参与者,和安慰剂组的49名参与者。安慰剂组研究期间体重减轻的总估计平均变化为7.03kg(95%CI,4.25-9.80kg),运动组11.19kg(95%CI,8.40-13.99kg),利拉鲁肽组13.74kg(95%CI,11.04-16.44kg),联合组16.88kg(95%CI,14.23-19.54kg)。在组合组中,与安慰剂组相比,髋部的BMD没有变化(平均变化,-0.006g/cm2;95%CI,-0.017至0.004g/cm2;P=.24)和腰椎(-0.010g/cm2;95%CI,-0.025至0.005g/cm2;P=.20)。与运动组相比,利拉鲁肽组髋部骨密度降低(平均变化,-0.013g/cm2;95%CI,-0.024至-0.001g/cm2;P=0.03)和脊柱(平均变化,-0.016g/cm2;95%CI,-0.032至-0.001g/cm2;P=.04)。
■在这项随机临床试验中,运动和GLP-1RA(利拉鲁肽)的组合是最有效的减重策略,同时保持骨骼健康.尽管体重减轻相似,但仅利拉鲁肽治疗在临床相关部位的BMD降低幅度大于仅运动。
■EudraCT:2015-005585-32。
UNASSIGNED: A major concern with weight loss is concomitant bone loss. Exercise and glucagon-like peptide-1 receptor agonists (GLP-1RAs) represent weight loss strategies that may protect bone mass despite weight loss.
UNASSIGNED: To investigate bone health at clinically relevant sites (hip, spine, and forearm) after diet-induced weight loss followed by a 1-year intervention with exercise,
liraglutide, or both combined.
UNASSIGNED: This study was a predefined secondary analysis of a randomized clinical trial conducted between August 2016 and November 2019 at the University of Copenhagen and Hvidovre Hospital in Denmark. Eligible participants included adults aged 18 to 65 years with obesity (body mass index of 32-43) and without diabetes. Data analysis was conducted from March to April 2023, with additional analysis in February 2024 during revision.
UNASSIGNED: After an 8-week low-calorie diet (800 kcal/day), participants were randomized to 1 of 4 groups for 52 weeks: a moderate- to vigorous-intensity exercise program (exercise alone), 3.0 mg daily of the GLP-1 RA
liraglutide (
liraglutide alone), the combination, or placebo.
UNASSIGNED: The primary outcome was change in site-specific bone mineral density (BMD) at the hip, lumbar spine, and distal forearm from before the low-calorie diet to the end of treatment, measured by dual-energy x-ray absorptiometry in the intention-to-treat population.
UNASSIGNED: In total, 195 participants (mean [SD] age, 42.84 [11.87] years; 124 female [64%] and 71 male [36%]; mean [SD] BMI, 37.00 [2.92]) were randomized, with 48 participants in the exercise group, 49 participants in the liraglutide group, 49 participants in the combination group, and 49 participants in the placebo group. The total estimated mean change in weight losses during the study was 7.03 kg (95% CI, 4.25-9.80 kg) in the placebo group, 11.19 kg (95% CI, 8.40-13.99 kg) in the exercise group, 13.74 kg (95% CI, 11.04-16.44 kg) in the liraglutide group, and 16.88 kg (95% CI, 14.23-19.54 kg) in the combination group. In the combination group, BMD was unchanged compared with the placebo group at the hip (mean change, -0.006 g/cm2; 95% CI, -0.017 to 0.004 g/cm2; P = .24) and lumbar spine (-0.010 g/cm2; 95% CI, -0.025 to 0.005 g/cm2; P = .20). Compared with the exercise group, BMD decreased for the
liraglutide group at the hip (mean change, -0.013 g/cm2; 95% CI, -0.024 to -0.001 g/cm2; P = .03) and spine (mean change, -0.016 g/cm2; 95% CI, -0.032 to -0.001 g/cm2; P = .04).
UNASSIGNED: In this randomized clinical trial, the combination of exercise and GLP-1RA (liraglutide) was the most effective weight loss strategy while preserving bone health.
Liraglutide treatment alone reduced BMD at clinically relevant sites more than exercise alone despite similar weight loss.
UNASSIGNED: EudraCT: 2015-005585-32.