{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:12:52Z","timestamp":1788973972164,"version":"build-2803163510"},"reference-count":35,"publisher":"Elsevier BV","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T00:00:00Z","timestamp":1753747200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"US Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","thelancet.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["The Lancet Healthy Longevity"],"published-print":{"date-parts":[[2025,9]]},"DOI":"10.1016\/j.lanhl.2025.100761","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T09:49:17Z","timestamp":1758620957000},"page":"100761","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":7,"title":["Bone quality response to lifestyle intervention in older adults with obesity (LIMB-Q trial): a randomised controlled trial"],"prefix":"10.1016","volume":"6","author":[{"given":"Giulia","family":"Gregori","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Mediwala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Liebschner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daeseung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mon S","family":"Bryant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Klonis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reina","family":"Armamento-Villareal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clifford","family":"Qualls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1365-7960","authenticated-orcid":false,"given":"Dennis T","family":"Villareal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.lanhl.2025.100761_bib1","doi-asserted-by":"crossref","first-page":"2284","DOI":"10.1001\/jama.2016.6458","article-title":"Trends in obesity among adults in the United States, 2005 to 2014","volume":"315","author":"Flegal","year":"2016","journal-title":"JAMA"},{"key":"10.1016\/j.lanhl.2025.100761_bib2","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1093\/ajcn\/82.5.923","article-title":"Obesity in older adults: technical review and position statement of the American Society for Nutrition and NAASO, The Obesity Society","volume":"82","author":"Villareal","year":"2005","journal-title":"Am J Clin Nutr"},{"key":"10.1016\/j.lanhl.2025.100761_bib3","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.exger.2013.02.005","article-title":"Weight loss in obese adults 65 years and older: a review of the controversy","volume":"48","author":"Waters","year":"2013","journal-title":"Exp Gerontol"},{"key":"10.1016\/j.lanhl.2025.100761_bib4","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s11154-020-09577-2","article-title":"Dietary weight-loss interventions for the management of obesity in older adults","volume":"21","author":"Goisser","year":"2020","journal-title":"Rev Endocr Metab Disord"},{"key":"10.1016\/j.lanhl.2025.100761_bib5","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1080\/21551197.2018.1564721","article-title":"Weight loss-induced reduction of bone mineral density in older adults with obesity","volume":"38","author":"Jiang","year":"2019","journal-title":"J Nutr Gerontol Geriatr"},{"key":"10.1016\/j.lanhl.2025.100761_bib6","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1159\/000500779","article-title":"Is weight loss harmful for skeletal health in obese older adults?","volume":"66","author":"Papageorgiou","year":"2020","journal-title":"Gerontology"},{"key":"10.1016\/j.lanhl.2025.100761_bib7","doi-asserted-by":"crossref","first-page":"2168","DOI":"10.1002\/jbmr.2564","article-title":"Does diet-induced weight loss lead to bone loss in overweight or obese adults? A systematic review and meta-analysis of clinical trials","volume":"30","author":"Zibellini","year":"2015","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib8","doi-asserted-by":"crossref","first-page":"2250","DOI":"10.1056\/NEJMra053077","article-title":"Bone quality\u2014the material and structural basis of bone strength and fragility","volume":"354","author":"Seeman","year":"2006","journal-title":"N Engl J Med"},{"key":"10.1016\/j.lanhl.2025.100761_bib9","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1146\/annurev.nutr.012809.104655","article-title":"Bone metabolism in obesity and weight loss","volume":"32","author":"Shapses","year":"2012","journal-title":"Annu Rev Nutr"},{"key":"10.1016\/j.lanhl.2025.100761_bib10","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/S2213-8587(24)00163-3","article-title":"Bone health in adults with obesity before and after interventions to promote weight loss","volume":"12","author":"Paccou","year":"2024","journal-title":"Lancet Diabetes Endocrinol"},{"key":"10.1016\/j.lanhl.2025.100761_bib11","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/ajcn\/nqy237","article-title":"Effect of a hypocaloric, nutritionally complete, higher-protein meal plan on bone density and quality in older adults with obesity: a randomized trial","volume":"109","author":"Weaver","year":"2019","journal-title":"Am J Clin Nutr"},{"key":"10.1016\/j.lanhl.2025.100761_bib12","doi-asserted-by":"crossref","first-page":"2140","DOI":"10.1002\/jbmr.3555","article-title":"Effect of exercise modality during weight loss on bone health in older adults with obesity and cardiovascular disease or metabolic syndrome: a randomized controlled trial","volume":"33","author":"Beavers","year":"2018","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib13","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/j.1474-9726.2010.00643.x","article-title":"Reduced bone mineral density is not associated with significantly reduced bone quality in men and women practicing long-term calorie restriction with adequate nutrition","volume":"10","author":"Villareal","year":"2011","journal-title":"Aging Cell"},{"key":"10.1016\/j.lanhl.2025.100761_bib14","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1002\/jbmr.1560","article-title":"Weight loss in obese older adults increases serum sclerostin and impairs hip geometry but both are prevented by exercise training","volume":"27","author":"Armamento-Villareal","year":"2012","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib15","doi-asserted-by":"crossref","first-page":"e466","DOI":"10.1210\/clinem\/dgad415","article-title":"Obesity and skeletal fragility","volume":"109","author":"Chen","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"10.1016\/j.lanhl.2025.100761_bib16","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1016\/j.amjmed.2011.06.013","article-title":"Obesity is not protective against fracture in postmenopausal women: GLOW","volume":"124","author":"Compston","year":"2011","journal-title":"Am J Med"},{"key":"10.1016\/j.lanhl.2025.100761_bib17","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.1007\/s00198-020-05438-5","article-title":"Guidelines for the assessment of bone density and microarchitecture in vivo using high-resolution peripheral quantitative computed tomography","volume":"31","author":"Whittier","year":"2020","journal-title":"Osteoporos Int"},{"key":"10.1016\/j.lanhl.2025.100761_bib18","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1007\/s00198-019-04935-6","article-title":"Validation of distal radius failure load predictions by homogenized- and micro-finite element analyses based on second-generation high-resolution peripheral quantitative CT images","volume":"30","author":"Arias-Moreno","year":"2019","journal-title":"Osteoporos Int"},{"key":"10.1016\/j.lanhl.2025.100761_bib19","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/S0736-0266(01)00185-1","article-title":"Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone","volume":"20","author":"Kopperdahl","year":"2002","journal-title":"J Orthop Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib20","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1359\/jbmr.060606","article-title":"Age- and sex-specific differences in the factor of risk for vertebral fracture: a population-based study using QCT","volume":"21","author":"Bouxsein","year":"2006","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib21","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1007\/s10439-025-03763-6","article-title":"High-fidelity finite element modeling technique to improve sensitivity to bone tissue changes of older adults with obesity undergoing intensive lifestyle intervention","volume":"53","author":"Liebschner","year":"2025","journal-title":"Ann Biomed Eng"},{"key":"10.1016\/j.lanhl.2025.100761_bib22","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1002\/jbmr.2176","article-title":"Trabecular bone score: a noninvasive analytical method based upon the DXA image","volume":"29","author":"Silva","year":"2014","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib23","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.bonr.2016.07.004","article-title":"Technical note: recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation","volume":"5","author":"Diez-Perez","year":"2016","journal-title":"Bone Rep"},{"key":"10.1016\/j.lanhl.2025.100761_bib24","doi-asserted-by":"crossref","first-page":"M350","DOI":"10.1093\/gerona\/55.6.M350","article-title":"Physical and performance measures for the identification of mild to moderate frailty","volume":"55","author":"Brown","year":"2000","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"10.1016\/j.lanhl.2025.100761_bib25","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.bone.2011.10.033","article-title":"Prediction of bone strength at the distal tibia by HR-pQCT and DXA","volume":"50","author":"Popp","year":"2012","journal-title":"Bone"},{"key":"10.1016\/j.lanhl.2025.100761_bib26","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1002\/jbmr.2069","article-title":"Assessment of incident spine and hip fractures in women and men using finite element analysis of CT scans","volume":"29","author":"Kopperdahl","year":"2014","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib27","doi-asserted-by":"crossref","DOI":"10.3389\/fphys.2023.1266292","article-title":"Utility of HR-pQCT in detecting training-induced changes in healthy adult bone morphology and microstructure","volume":"14","author":"Sekel","year":"2023","journal-title":"Front Physiol"},{"key":"10.1016\/j.lanhl.2025.100761_bib28","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1210\/jc.2008-1807","article-title":"Once-monthly oral ibandronate improves biomechanical determinants of bone strength in women with postmenopausal osteoporosis","volume":"94","author":"Lewiecki","year":"2009","journal-title":"J Clin Endocrinol Metab"},{"key":"10.1016\/j.lanhl.2025.100761_bib29","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1210\/jc.2013-1047","article-title":"Abdominal fat is associated with lower bone formation and inferior bone quality in healthy premenopausal women: a transiliac bone biopsy study","volume":"98","author":"Cohen","year":"2013","journal-title":"J Clin Endocrinol Metab"},{"key":"10.1016\/j.lanhl.2025.100761_bib30","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1126\/science.1188280","article-title":"Sfrp5 is an anti-inflammatory adipokine that modulates metabolic dysfunction in obesity","volume":"329","author":"Ouchi","year":"2010","journal-title":"Science"},{"key":"10.1016\/j.lanhl.2025.100761_bib31","article-title":"The effect of inflammation on bone","volume":"11","author":"Epsley","year":"2020","journal-title":"Front Physiol"},{"key":"10.1016\/j.lanhl.2025.100761_bib32","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1038\/oby.2004.111","article-title":"Physical frailty and body composition in obese elderly men and women","volume":"12","author":"Villareal","year":"2004","journal-title":"Obes Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib33","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1056\/NEJMoa1616338","article-title":"Aerobic or resistance exercise, or both, in dieting obese older adults","volume":"376","author":"Villareal","year":"2017","journal-title":"N Engl J Med"},{"key":"10.1016\/j.lanhl.2025.100761_bib34","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1002\/jbmr.3214","article-title":"The effect of intentional weight loss on fracture risk in persons with diabetes: results from the look AHEAD randomized clinical trial","volume":"32","author":"Johnson","year":"2017","journal-title":"J Bone Miner Res"},{"key":"10.1016\/j.lanhl.2025.100761_bib35","doi-asserted-by":"crossref","first-page":"2266","DOI":"10.1111\/jgs.18816","article-title":"Should the Incretin hype be the same for older adults: promise + cautions","volume":"72","author":"Batsis","year":"2024","journal-title":"J Am Geriatr Soc"}],"container-title":["The Lancet Healthy Longevity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666756825000807?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2666756825000807?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T09:16:35Z","timestamp":1778922995000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2666756825000807"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":35,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["S2666756825000807"],"URL":"https:\/\/doi.org\/10.1016\/j.lanhl.2025.100761","relation":{},"ISSN":["2666-7568"],"issn-type":[{"value":"2666-7568","type":"print"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Bone quality response to lifestyle intervention in older adults with obesity (LIMB-Q trial): a randomised controlled trial","name":"articletitle","label":"Article Title"},{"value":"The Lancet Healthy Longevity","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.lanhl.2025.100761","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"Published by Elsevier Ltd.","name":"copyright","label":"Copyright"}],"article-number":"100761"}}