A combined nutritional and activity lifestyle intervention significantly improved BMD of males with good bone health at baseline while at the same time improving metabolic health, suggesting that nutritional weight-loss interventions may not harm BMD when combined with exercise.
Key Findings
Results
The 13-week combined caloric restriction and physical activity intervention significantly reduced body weight in both males and females.
Body weight reduced by 3.3 kg in males (fdr < 0.001) and 3.4 kg in females (fdr < 0.001)
134 participants with mean age 62.9 years, 49% female
Intervention consisted of 12.5% caloric restriction and 12.5% increase in physical activity over 13 weeks
Study was a single-arm trial (Growing Old TOgether [GOTO] trial)
Results
The intervention significantly reduced lean mass in both males and females.
Lean mass reduced by 1.4 kg in males (fdr < 0.001)
Lean mass reduced by 1.1 kg in females (fdr < 0.001)
Lean mass loss was measured using dual-energy X-ray absorptiometry (DEXA)
Results
Total body fat percentage was significantly reduced in both males and females following the intervention.
Total body fat% reduced by 1.5% in males (fdr < 0.001)
Total body fat% reduced by 1.5% in females (fdr < 0.001)
Fat mass was assessed using DEXA
Results
Lumbar spine BMD and total body BMD significantly increased in males following the combined intervention.
Lumbar spine BMD increased by 3.0% in males (fdr < 0.001)
Total body BMD increased by 0.7% in males (fdr = 0.002)
BMD was evaluated using dual-energy X-ray absorptiometry (DEXA)
Results
In females, lumbar spine BMD showed only a trend toward increase and total body BMD remained stable.
Lumbar spine BMD showed a trend in the upwards direction of 1.2% in females (fdr = 0.09)
Total body BMD in females was stable with a non-significant change of 0.4% (fdr = 0.07)
Neither BMD outcome reached statistical significance in females
Results
In males, the increase in lumbar spine BMD was significantly associated with decreases in weight, body fat percentage, trunk fat percentage, and improved immune-metabolic health.
Increase in lumbar spine BMD was associated with decreased weight (fdr = 0.001)
Association with decreased body fat% (fdr = 0.001) and trunk fat% (fdr = 0.001)
Association with improved immune-metabolic health (fdr = 0.02)
These associations were observed specifically in males
Results
Males with higher baseline BMD but a poor metabolite-based health score at baseline showed a stronger increase in lumbar spine BMD.
The association was statistically significant (fdr = 0.03)
This interaction was found only in males
Two composite metabolite-based immune-metabolic health scores were used as part of the analysis
Background
The study population consisted of healthy, non-obese middle-aged to older adults, distinguishing it from prior research on nutritional weight-loss interventions and BMD.
134 participants with mean age 62.9 years and 49% female
The combined effect of nutritional and activity interventions on BMD was noted to be 'not well studied in non-obese adults'
This was an ancillary study of the single-arm GOTO trial (registration number GOTNL3301)
Bogaards F, Groenendijk I, Gehrmann T, Beekman M, Lakenberg N, Suchiman H, et al.. (2026). Effects of a Combined Dietary and Physical Activity Intervention on Bone Density, Lean Mass and Fat Mass in Adults: The GOTO Trial.. Journal of cachexia, sarcopenia and muscle. https://doi.org/10.1002/jcsm.70226