The Effects of Obesity and Weight Loss Interventions on Bone Health: A Narrative Review.

PURPOSE OF REVIEW: This review explores the effects of obesity and weight loss on bone and musculoskeletal health.

RECENT FINDINGS: Obesity is associated with lower bone turnover, higher bone mineral density (BMD) and reduced risk of hip and wrist fractures, although ankle and lower leg fractures may be more frequent. In contrast, weight loss increases bone turnover, especially bone resorption, reduces BMD, especially at cortical sites, and increases fracture risk, especially at the hip and wrist. Skeletal adverse events depend on the magnitude of weight loss and are more prominent following bariatric surgery. Changes in mechanical loading, loss of muscle mass, hormonal alterations, and nutrient/vitamin deficiencies are implicated. Emerging anti-obesity medications may have a positive effect on bone and partially compensate the negative impact of weight loss. Regular exercise, vitamin D supplementation, adequate calcium and protein intake can mitigate these effects. Identification of the effects of excess body weight and the benefit-to-risk balance of weight loss interventions on bone health may help improve clinical management of invididuals with obesity and related metabolic disorders.