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Bone quality response to lifestyle intervention in older adults with obesity (LIMB-Q trial): a randomised controlled trial

Gregori G, Mediwala S, Liebschner M, Kim D, Bryant MS, Klonis N, Armamento-Villareal R, Qualls C et al.

The lancet. Healthy longevity, 2025

138 participants · 5 citations

Abstract

Background: Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density.

Methods: The Lifestyle Intervention to Improve Bone Quality (LIMB-Q) study was a randomised controlled trial conducted at Baylor College of Medicine and the Michael E DeBakey VA Medical Center (Houston, TX, USA) including older adults (aged 65-85 years) with obesity (BMI ≥30 kg/m2). Participants were randomly assigned to receive either an intensive lifestyle intervention (intensive lifestyle group, consisting of weight management plus exercise training) or healthy lifestyle (healthy lifestyle group, consisting of educational sessions on healthy diets). The co-primary outcomes were 12-month changes in (1) distal tibia cortical thickness, measured using high-resolution peripheral quantitative CT, and (2) hip bone strength (failure load), assessed via finite element analysis of CT scans. The primary endpoint was analysed by intention to treat (all randomly assigned patients). This trial is registered with ClinicalTrials.gov, NCT03329963 (completed).

Findings: Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was…

How strong is the evidence?

Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 138 participants or records.

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