A post hoc analysis of the IDEA trial, a prospective, randomized trial involving overweight and obese patients aged ≥55 years with osteoarthritis, reveals that serum markers of matrix metalloproteinase-mediated type I collagen degradation are lower among patients undergoing diet-induced weight loss, with or without exercise, at 18 months than in patients undertaking exercise only. No changes in markers of type II collagen degradation were observed in blood samples from patients in any of the intervention groups (429 patients in total).