Revisiting the relationship between weight loss and bone health in people living with obesity: insights from the latest evidence

PURPOSE OF REVIEW: This review summarizes recent advances in understanding bone outcomes associated with lifestyle, surgical, and pharmacological weight-loss strategies. RECENT FINDINGS: Lifestyle-induced weight loss achieved through calorie restriction is consistently associated with reductions in hip areal bone mineral density (aBMD) when weight loss is clinically meaningful. However, recent randomized controlled trials show that structured lifestyle interventions incorporating resistance exercise and adequate nutritional support can mitigate bone loss and preserve bone strength. These studies also emphasize the added value of advanced imaging techniques for evaluating bone quality beyond aBMD alone. In the surgical setting, accumulating evidence clarifies the detrimental skeletal effects of sleeve gastrectomy and other bariatric procedures, with postmenopausal women and adults over 60 years at particularly high risk. Preventive approaches, including targeted physical activity and antiresorptive therapies, are under active investigation. In parallel, emerging data on antiobesity medications are beginning to elucidate their skeletal effects, including changes in bone microarchitecture and fracture risk. SUMMARY: Lifestyle interventions can attenuate skeletal impairment and preserve bone quality during calorie-restriction-induced weight loss. In contrast, bariatric surgery, particularly sleeve gastrectomy, adversely affects bone health, especially in postmenopausal women. The skeletal impact of antiobesity medications remains incompletely defined and warrants further study.