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Diet puzzle: Low fat intake can lead to bone loss in women

Tuesday, August 17, 1999

By Ellen Mazo, Post-Gazette Staff Writer

Women who lose even a small amount of weight on a low-fat diet experience bone loss, according to a study published in the July issue of The American Journal of Clinical Nutrition.

The findings, based on an 18-month study of 236 white, healthy premenopausal women, clearly concerned the researchers at the University of Pittsburgh because the average weight loss was so modest -- only 7 pounds.

"Most women are constantly dieting, so the repercussions are huge," said Loran Salamone, the study's lead author and assistant professor of epidemiology at Pitt's Graduate School of Public Health. "It's scary because it [contradicts] cardiovascular recommendations to follow a low-fat, high calcium diet."

Researchers did find that the women who lost weight and increased their exercise regimen had less bone loss in the spine. Studies have shown that weight-bearing exercise such as running, jumping and even walking can slow the loss of bone, however, no one is sure how much exercise is necessary.

Women lose about 1 to 2 percent of bone density a year around menopause, but during the 12-month period of menopause the rate can go to 2 to 5 percent, Salamone said.

The findings are based on the $2.2 million Women's Healthy Lifestyle Project, the first clinical trial to determine whether working closely with premenopausal women could help them improve eating and exercise habits -- and reduce their risk for heart disease by lowering body weight and LDL ("bad") cholesterol.

As a woman begins to go through menopause, her ovaries stop producing enough estrogen to sufficiently stimulate the lining of her uterus and vagina. To compensate for the loss of estrogen, her body retains fat, which contains the hormone.

Women often gain one to two pounds the year before and during menopause, while some gain up to 10 pounds over a three-year period.

At issue is the fact that weight gain among older women can lead to diabetes, heart disease and breast, uterine and colon cancer.

"It's a tricky message," conceded Dr. Lewis Kuller, one of the principal investigators who is chairman of the school's epidemiology department. "Heavier women have higher estrogen levels [from the higher fat levels] and less bone loss. But the reality is there is a higher risk level among heavier women for cancer, heart disease, hypertension."

Initial findings last year among the participants, who ranged in age from 44 to 50 when they joined the study in 1992, showed a drop in bad cholesterol levels with the weight loss.

"Clearly, the answer is for all women to monitor their bone density if they decide to lose weight," said Kuller. "We now have drug therapies that can help diminish bone loss."

Some health insurers pay for bone scans for women who are considered at risk for the brittle bone disease of osteoporosis. Average cost of the tests is $350.

"It comes down to choosing your destiny," Salamone said. "If you have a strong family history of osteoporosis, your emphasis should be on monitoring that. It's a personal decision. You have to decide what's right for you."

Salamone and Kuller plan to continue research to determine whether the intensity and duration of exercise can produce beneficial effects.

Results after 54 months of testing of the women are expected to be published later this fall.



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