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Abstract
The interaction between obesity and bone metabolism is complex. The effects of fat on the skeleton are mediated by both mechanical and biochemical factors. Though obesity is characterized by higher bone mineral density, studies conducted on bone microarchitecture have produced conflicting results. The majority of studies indicate that obesity has a positive effect on skeletal strength, even though most likely the effects are site-dependent and, in fact, obese individuals might be at risk of certain types of fractures. Mechanical loading and higher lean mass are associated with improved outcomes, whereas systemic inflammation, observed especially with abdominal obesity, may exert negative effects. Weight loss interventions likely lead to bone loss over time. Pharmacological treatment options seem to be safe in terms of skeletal health; however, the skeletal effects of bariatric surgery are dependent on the type of surgical procedure. Malabsorptive procedures are associated with higher short-term adverse effects on bone health. In this narrative review, we discuss the effects of obesity and weight loss interventions on skeletal health.
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Affiliation(s)
- Christos Savvidis
- Department of Endocrinology, Hippokrateion General Hospital, Athens, Greece
| | - Symeon Tournis
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", KAT hospital, Medical school, Athens, Greece
| | - Anastasia D Dede
- Laboratory for Research of the Musculoskeletal System "Th. Garofalidis", KAT hospital, Medical school, Athens, Greece.
- Department of Endocrinology and Diabetes, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK.
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Gagnon C, Schafer AL. Bone Health After Bariatric Surgery. JBMR Plus 2018; 2:121-133. [PMID: 30283897 PMCID: PMC6124196 DOI: 10.1002/jbm4.10048] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 03/13/2018] [Accepted: 03/26/2018] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery results in long-term weight loss and improvement or resolution in obesity-related comorbidities. However, mounting evidence indicates that it adversely affects bone health. This review summarizes clinical research findings about the impact of bariatric surgery on skeletal outcomes. The literature is the largest and strongest for the Roux-en-Y gastric bypass (RYGB) procedure, as RYGB was the most commonly performed bariatric procedure worldwide until it was very recently overtaken by the sleeve gastrectomy (SG). Because SG is a newer procedure, its skeletal effects have not yet been well defined. Epidemiologic studies have now demonstrated an increased risk of fracture after RYGB and biliopancreatic diversion with duodenal switch, both of which include a malabsorptive component. As these epidemiologic data have emerged, patient-oriented studies have elucidated the bone tissue-level changes that may account for the heightened skeletal fragility. Bariatric surgery induces early and dramatic increases in biochemical markers of bone turnover. A notable feature of recent patient-oriented clinical studies is the application of advanced skeletal imaging modalities; studies address the limitations of dual-energy X-ray absorptiometry (DXA) by using quantitative computed tomography (QCT)-based modalities to examine volumetric bone mineral density and compartment-specific density and microstructure. RYGB results in pronounced declines in bone mass at the axial skeleton demonstrated by DXA and QCT, as well as at the appendicular skeleton demonstrated by high-resolution peripheral quantitative computed tomography (HR-pQCT). RYGB has detrimental effects on trabecular and cortical microarchitecture and estimated bone strength. Skeletal changes after RYGB appear early and continue even after weight loss plateaus and weight stabilizes. The skeletal effects of bariatric surgery are presumably multifactorial, and mechanisms may involve nutritional factors, mechanical unloading, hormonal factors, and changes in body composition and bone marrow fat. Clinical guidelines address bone health and may mitigate the negative skeletal effects of surgery, although more research is needed to direct and support such guidelines. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Claudia Gagnon
- Department of MedicineUniversité LavalQuebec CityCanada
- Endocrinology and Nephrology UnitCHU de Quebec Research CentreQuebec CityCanada
- Institute of Nutrition and Functional FoodsUniversité LavalQuebec CityCanada
- Quebec Heart and Lung Institute Research CentreQuébec CityCanada
| | - Anne L Schafer
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
- Endocrine Research UnitSan Francisco Veterans Affairs Heath Care SystemSan FranciscoCAUSA
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Zhang Q, Chen Y, Li J, Chen D, Cheng Z, Xu S, Huang Y, Wang Q. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev 2018; 19:728-736. [PMID: 29334691 DOI: 10.1111/obr.12665] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Abstract
Bariatric surgery effectively treats morbid obesity. However, the negative effect of this surgery on the bone is concerning. The aim of this meta-analysis was to investigate the fracture risk associated with bariatric surgery in morbidly obese subjects. Relevant studies published from database inception to September 2017 were identified in PubMed, Embase and the Cochrane Library. The Newcastle-Ottawa Scale was used to evaluate the quality of the observational studies, and the Jadad score evaluated randomized controlled trials. Among the 1003 studies initially identified, five observational trials and one randomized controlled trial were eligible for inclusion. All studies included in the meta-analysis were considered high quality. Risk for any type of fracture was higher in the surgical group than in the non-surgical group (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.18-1.42). After surgery, the fracture risk in non-vertebral sites was significantly increased, especially in the upper limbs (RR 1.42, 95% CI 1.08-1.87; and RR 1.68, 95% CI 1.15-2.45). Compared with those with restrictive procedures, subjects who underwent mixed restrictive and malabsorptive procedures tended to have an increased fracture risk (RR 1.54, 95% CI 0.96-2.46). To conclude, bariatric surgery is associated with an increased risk of total and non-vertebral fractures, especially in the upper limbs.
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Affiliation(s)
- Q Zhang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Chen
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - J Li
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - D Chen
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Z Cheng
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - S Xu
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Huang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Q Wang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Unraveling the compromised biomechanical performance of type 2 diabetes- and Roux-en-Y gastric bypass bone by linking mechanical-structural and physico-chemical properties. Sci Rep 2018; 8:5881. [PMID: 29651097 PMCID: PMC5897570 DOI: 10.1038/s41598-018-24229-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/06/2018] [Indexed: 02/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with obesity and hyperglycemia. Roux-en-Y gastric bypass (RYGB) surgery is a common treatment for severely obese patients and T2DM. Both RYGB and T2DM are linked to increased skeletal fragility, though the exact mechanisms are poorly understood. Our aim was to characterize the structural, mechanical and compositional properties of bones from diet-induced obese and RYGB-treated obese (bypass) mice to elucidate which the exact factors are contributing to the increased skeletal fragility. To achieve this, a combinatory approach including microfocus X-ray computed tomography, 3-point bending, finite element modeling and Raman spectroscopy, was used. Compared to aged-matched lean controls, the obese mice displayed decreased cortical thickness, trabecular bone loss, decreased stiffness and increased Young’s modulus. For the bypass mice, these alterations were even more pronounced, and additionally they showed low mineral-to-matrix ratio in the cortical endosteal area. Accumulation of the advanced glycation end-product (AGE) pentosidine was found in the cortex of obese and bypass groups and this accumulation was correlated with an increased Young’s modulus. In conclusion, we found that the increased fracture risk in T2DM- and post-RYGB bones is mainly driven by accumulation of AGEs and macro-structural alterations, generating biomechanical dysfunctionality.
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Borges JLC, Miranda ISDM, Sarquis MMS, Borba V, Maeda SS, Lazaretti-Castro M, Blinkey N. Obesity, Bariatric Surgery, and Vitamin D. J Clin Densitom 2018; 21:157-162. [PMID: 28427988 DOI: 10.1016/j.jocd.2017.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 02/02/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Abstract
The high prevalence of obesity is a worldwide problem associated with multiple comorbidities, including cardiovascular diseases. Vitamin D deficiency with secondary hyperparathyroidism is common in obese individuals and can be aggravated after bariatric surgery. Moreover, there is no consensus on the optimal supplementation dose of vitamin D in postbariatric surgical patients. We present new data on the variability of 25(OH)D response to supplementation in postmenopausal obese women. It is important to recognize and treat vitamin D deficiency before bariatric surgery to avoid postoperative complications, such as metabolic bone disease with associated high fracture risk. The objective of this article is to discuss the bone metabolism consequences of vitamin D deficiency after bariatric surgery.
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Affiliation(s)
| | | | | | - Victoria Borba
- Disciplina de Endocrinologia, Universidade Federal do Paraná, Brazil
| | - Sergio Setsuo Maeda
- Disciplina de Endocrinologia, Universidade Federal de Sao Paulo-Escola Paulista de Medicina, Brazil
| | - Marise Lazaretti-Castro
- Disciplina de Endocrinologia, Universidade Federal de Sao Paulo-Escola Paulista de Medicina, Brazil
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Corbeels K, Verlinden L, Lannoo M, Simoens C, Matthys C, Verstuyf A, Meulemans A, Carmeliet G, Van der Schueren B. Thin bones: Vitamin D and calcium handling after bariatric surgery. Bone Rep 2018; 8:57-63. [PMID: 29955623 PMCID: PMC6019966 DOI: 10.1016/j.bonr.2018.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/25/2018] [Accepted: 02/01/2018] [Indexed: 02/06/2023] Open
Abstract
Bariatric surgery has proven to be a valuable treatment option for morbid obesity. However, these procedures can lead to impaired intestinal absorption of calcium and vitamin D, thereby challenging calcium homeostasis and possibly contributing to bone loss leading to an increased fracture risk. Besides calcium and vitamin D malabsorption, hormonal changes occurring after surgery can also be the source of observed bone loss. In this review, first, a case report will be discussed, highlighting the relevance of this topic. Afterwards, changes in bone density and fracture risk, after the two most performed types of bariatric surgery, Sleeve Gastrectomy (SG) and Roux-en-Y Gastric Bypass (RYGB) will be discussed. In addition, we discuss the putative underlying mechanisms leading to bone changes based on both preclinical and clinical observations. Nonetheless, it is clear further research is needed to further elucidate the exact mechanisms of bone loss following bariatric surgery and subsequently identify potential treatment options for bone preservation. Bariatric surgery induces bone loss and leads to increased fracture risk. Bone resorption increases after both SG and, more strongly, after RYGB. Malabsorption and adipose tissue-related hormones likely contribute to bone loss.
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Affiliation(s)
- Katrien Corbeels
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Lieve Verlinden
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Matthias Lannoo
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Caroline Simoens
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium.,KU Leuven, Department of Cellular and Molecular Medicine, Laboratory of Ion Channel Research, VIB Center for Brain and Disease Research, Leuven, Belgium
| | - Christophe Matthys
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Annemieke Verstuyf
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Ann Meulemans
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Geert Carmeliet
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
| | - Bart Van der Schueren
- KU Leuven, Department of Chronic Diseases, Metabolism & Ageing (CHROMETA), Clinical and Experimental Endocrinology, Leuven, Belgium
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Is Trabecular Bone Score Valuable in Bone Microstructure Assessment after Gastric Bypass in Women with Morbid Obesity? Nutrients 2017; 9:nu9121314. [PMID: 29207490 PMCID: PMC5748764 DOI: 10.3390/nu9121314] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/22/2017] [Accepted: 11/28/2017] [Indexed: 12/18/2022] Open
Abstract
Introduction: The effects of bariatric surgery on skeletal health raise many concerns. Trabecular bone score (TBS) is obtained through the analysis of lumbar spine dual X-ray absorptiometry (DXA) images and allows an indirect assessment of skeletal microarchitecture (MA). The aim of our study was to evaluate the changes in bone mineral density (BMD) and alterations in bone microarchitecture assessed by TBS in morbidly obese women undergoing Roux-en-Y gastric bypass (RYGB), over a three-year follow-up. Material/Methods: A prospective study of 38 morbidly obese white women, aged 46.3 ± 8.2 years, undergoing RYGB was conducted. Biochemical analyses and DXA scans with TBS evaluation were performed before and at one year and three years after surgery. Results: Patients showed normal calcium and phosphorus plasma concentrations throughout the study. However, 25-hydroxyvitamin D (25(OH)D3) decreased, and 71% of patients had a vitamin D deficiency at three years. BMD at femoral neck and lumbar spine (LSBMD) significantly decreased 13.53 ± 5.42% and 6.03 ± 6.79%, respectively, during the three-year follow-up; however Z-score values remained above those for women of the same age. TBS was within normal ranges at one and three years (1.431 ± 106 and 1.413 ± 85, respectively), and at the end of the study, 73.7% of patients had normal bone MA. TBS at three years correlated inversely with age (r = −0.41, p = 0.010), body fat (r = −0.465, p = 0.004) and greater body fat deposited in trunk (r = −0.48, p = 0.004), and positively with LSBMD (r = 0.433, p = 0.007), fat mass loss (r = 0.438, p = 0.007) and lean mass loss (r = 0.432, p = 0.008). In the regression analysis, TBS remained associated with body fat (β = −0.625, p = 0.031; R2 = 0.47). The fracture risk, calculated by FRAX® (University of Sheffield, Sheffield, UK), with and without adjustment by TBS, was low. Conclusion: Women undergoing RYGB in the mid-term have a preserved bone MA, assessed by TBS.
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58
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Ko BJ, Myung SK, Cho KH, Park YG, Kim SG, Kim DH, Kim SM. Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis. Obes Surg 2017; 26:1414-21. [PMID: 26464244 DOI: 10.1007/s11695-015-1928-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A meta-analysis regarding bone loss after bariatric surgery, designed to compare surgical and nonsurgical groups, has not yet been performed. Therefore, we performed a meta-analysis to compare the differences between bariatric surgical groups and nonoperated controls with regard to bone mineral density. METHODS In March 2015, we performed a review of the literature using PubMed, EMBASE, and the Cochrane Library. The search focused on retrospective and prospective studies, including but not limited to randomized studies published in English. RESULTS Among 1299 studies that were initially screened, ten met the selection criteria. For all types of bariatric surgery, bone density at the femoral neck was lower in the surgical group than in the nonsurgical control group (mean difference [MD] -0.05 g/cm(2); 95 % confidence interval [CI], -0.07 to -0.02; p = 0.001); no difference in bone density was found between the two groups at the lumbar spine (MD -0.01 g/cm(2); 95 % CI -0.07 to 0.05; p = 0.661). The analysis of Roux-en-Y gastric bypass showed similar results. CONCLUSION Bone density at the femoral neck decreased after bariatric surgery, compared to that in nonsurgical controls, whereas bone density at the lumbar spine did not show a difference between groups. Further larger scale studies with comparative nonsurgical controls are warranted to overcome the heterogeneity among studies in this analysis and to add evidence of possible bone loss subsequent to bariatric surgical procedures.
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Affiliation(s)
- Byung-Joon Ko
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, 100-742, South Korea
| | - Seung Kwon Myung
- Molecular Epidemiological Branch, Research Institute, National Cancer Center, Goyang, 410-769, South Korea.,Department of Family Medicine, Hospital, National Cancer Center, Goyang, 410-769, South Korea.,Center for Cancer Prevention and Detection, Hospital, National Cancer Center, Goyang, 410-769, South Korea
| | - Kyung-Hwan Cho
- Department of Family Medicine, College of Medicine, Korea University, Seoul, 136-705, South Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, 137-701, South Korea
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, 136-705, South Korea
| | - Do Hoon Kim
- Department of Family Medicine, College of Medicine, Korea University, Seoul, 136-705, South Korea
| | - Seon Mee Kim
- Department of Family Medicine, College of Medicine, Korea University, Seoul, 136-705, South Korea.
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59
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Crawford MR, Pham N, Khan L, Bena JF, Schauer PR, Kashyap SR. INCREASED BONE TURNOVER IN TYPE 2 DIABETES PATIENTS RANDOMIZED TO BARIATRIC SURGERY VERSUS MEDICAL THERAPY AT 5 YEARS. Endocr Pract 2017; 24:256-264. [PMID: 29144812 DOI: 10.4158/ep-2017-0072] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of our study was to determine the 5-year outcomes of bariatric surgery versus intensive medical therapy on bone turnover in patients with type 2 diabetes mellitus (T2DM) from the STAMPEDE trial. METHODS This was an ancillary investigation of a 5-year randomized control trial at a single tertiary care center involving 95 patients aged 48.5 ± 8 years with obesity (body mass index [BMI], 36.5 ± 3.6 kg/m2) and uncontrolled T2DM (glycated hemoglobin 9.3 ± 1.6% [78 mmol/mol]). Patients were randomized to intensive medical therapy (IMT; n = 25), Roux-en-Y gastric bypass (RYGB; n = 37), or sleeve gastrectomy (SG; n = 33) for diabetes treatment. Bone formation marker osteocalcin (OC), bone resorption marker serum C-telopeptide of type 1 collagen (CTX), and intact parathyroid hormone (PTH) were assessed at baseline and 5 years postintervention. Analysis with key clinical parameters and outcomes (i.e., age, menopausal status, gender, weight loss) was performed. RESULTS Percent change in CTX at 5 years increased in both surgical groups, by 137 ± 108% in RYGB ( P<.001) and 61.1 ± 90% in SG ( P<.001) compared to 29.8 ± 93% in IMT ( P = .12). OC also increased from baseline in the surgical cohorts, by 138 ± 19% in RYGB ( P<.001) and 71 ± 69% in SG ( P<.001) compared to 43.8 ± 121.1% in IMT ( P = .83). Increases in both CTX and OC correlated linearly with increases in PTH levels in RYGB patients ( P<.001). Increase in CTX correlated with decreased BMI in SG patients ( P = .039). CONCLUSION In patients with T2DM, bone turnover remains chronically elevated at 5 years following RYGB, and to a lesser extent in SG patients. ABBREVIATIONS BMI = body mass index; BTM = bone turnover marker; CTX = C-telopeptide of type 1 collagen; HbA1c = glycated hemoglobin; IMT = intensive medical therapy; OC = osteocalcin; PPI = proton-pump inhibitor; PTH = parathyroid hormone; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; T2DM = type 2 diabetes mellitus; TZD = thiazolidinedione.
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61
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Kim TY, Schwartz AV, Li X, Xu K, Black DM, Petrenko DM, Stewart L, Rogers SJ, Posselt AM, Carter JT, Shoback DM, Schafer AL. Bone Marrow Fat Changes After Gastric Bypass Surgery Are Associated With Loss of Bone Mass. J Bone Miner Res 2017; 32:2239-2247. [PMID: 28791737 PMCID: PMC5685913 DOI: 10.1002/jbmr.3212] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/19/2017] [Accepted: 06/26/2017] [Indexed: 12/22/2022]
Abstract
Bone marrow fat is a unique fat depot that may regulate bone metabolism. Marrow fat is increased in states of low bone mass, severe underweight, and diabetes. However, longitudinal effects of weight loss and improved glucose homeostasis on marrow fat are unclear, as is the relationship between marrow fat and bone mineral density (BMD) changes. We hypothesized that after Roux-en-Y gastric bypass (RYGB) surgery, marrow fat changes are associated with BMD loss. We enrolled 30 obese women, stratified by diabetes status. Before and 6 months after RYGB, we measured BMD by dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and vertebral marrow fat content by magnetic resonance spectroscopy. At baseline, those with higher marrow fat had lower BMD. Postoperatively, total body fat declined dramatically in all participants. Effects of RYGB on marrow fat differed by diabetes status (p = 0.03). Nondiabetic women showed no significant mean change in marrow fat (+1.8%, 95% confidence interval [CI] -1.8% to +5.4%, p = 0.29), although those who lost more total body fat were more likely to have marrow fat increases (r = -0.70, p = 0.01). In contrast, diabetic women demonstrated a mean marrow fat change of -6.5% (95% CI -13.1% to 0%, p = 0.05). Overall, those with greater improvements in hemoglobin A1c had decreases in marrow fat (r = 0.50, p = 0.01). Increases in IGF-1, a potential mediator of the marrow fat-bone relationship, were associated with marrow fat declines (r = -0.40, p = 0.05). Spinal volumetric BMD decreased by 6.4% ± 5.9% (p < 0.01), and femoral neck areal BMD decreased by 4.3% ± 4.1% (p < 0.01). Marrow fat and BMD changes were negatively associated, such that those with marrow fat increases had more BMD loss at both spine (r = -0.58, p < 0.01) and femoral neck (r = -0.49, p = 0.01), independent of age and menopause. Our findings suggest that glucose metabolism and weight loss may influence marrow fat behavior, and marrow fat may be a determinant of bone metabolism. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tiffany Y Kim
- Department of Medicine, University of California, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Kaipin Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Dimitry M Petrenko
- Department of Medicine, University of California, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Lygia Stewart
- Department of Surgery, University of California, San Francisco, CA, USA
- Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Stanley J Rogers
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Andrew M Posselt
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Jonathan T Carter
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Dolores M Shoback
- Department of Medicine, University of California, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Anne L Schafer
- Department of Medicine, University of California, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Quilliot D, Sirveaux MA, Ziegler O, Reibel N, Brunaud L. Carences en vitamines, minéraux et éléments traces, et dénutrition après chirurgie de l’obésité. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schafer AL. Vitamin D and intestinal calcium transport after bariatric surgery. J Steroid Biochem Mol Biol 2017; 173:202-210. [PMID: 28027914 PMCID: PMC5483209 DOI: 10.1016/j.jsbmb.2016.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients.
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Affiliation(s)
- Anne L Schafer
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, United States; Departments of Medicine and of Epidemiology & Biostatistics, University of California, San Francisco, United States.
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Campanha-Versiani L, Pereira DAG, Ribeiro-Samora GA, Ramos AV, de Sander Diniz MFH, De Marco LA, Soares MMS. The Effect of a Muscle Weight-Bearing and Aerobic Exercise Program on the Body Composition, Muscular Strength, Biochemical Markers, and Bone Mass of Obese Patients Who Have Undergone Gastric Bypass Surgery. Obes Surg 2017; 27:2129-2137. [PMID: 28285470 DOI: 10.1007/s11695-017-2618-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of an exercise program on the body composition, muscular strength (MS), biochemical markers, and bone mineral density (BMD) of individuals undergoing gastric bypass is unclear. We assessed lean mass (LM), MS, bone remodeling markers, and BMD before and after supervised weight-bearing and aerobic exercise training in obese patients who underwent Roux-en-Y gastric bypass (RYGB). METHODS This study included 37 obese patients (81.1% women, mean age 38.2 years, mean body mass index 42.4 ± 0.5 kg/m2). Whole body densitometry was used to evaluate pre- and postoperative BMD, total body fat, and LM. Serum calcium, parathyroid hormone, 25-hydroxyvitamin D, and bone remodeling markers were measured. MS was determined through the concentric 10 repetition maximum test. Postoperatively, participants were divided into two groups: the training group, who followed an exercise program (TG, n = 18), and the control group, who did not (CG, n = 19). RESULTS After 1 year, the TG showed a lower decrease in total BMD and at the lumbar spine and right hip compared with the CG (p < 0.001). The TG had lower mass reduction and an increase in upper limb LM compared with the CG (both p < 0.05). There was no significant difference between groups in bone markers or calcium metabolism. MS was higher in the TG than the CG (p < 0.05). CONCLUSION The supervised exercise program attenuated lumbar spine and right hip BMD loss and improved LM in the arms and overall MS but did not affect bone remodeling.
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Affiliation(s)
- Luciana Campanha-Versiani
- ICBS, University Center's of Belo Horizonte (UNI-BH), Professor Mario Werneck Avenue, 1685 Estoril, Belo Horizonte, MG, 30455-610, Brazil.
| | | | | | | | | | | | - Maria Marta Sarquis Soares
- Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.,Felício Rocho Hospital, Belo Horizonte, Brazil
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65
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Melo TL, Froeder L, Baia LDC, Heilberg IP. Bone turnover after bariatric surgery. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:332-336. [PMID: 28724055 PMCID: PMC10118938 DOI: 10.1590/2359-3997000000279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate parameters of bone and mineral metabolism after bariatric surgery. SUBJECTS AND METHODS This sectional study included data from medical records from 61 bariatric surgery (BS) patients (minimum period of 6 months after the procedure) and from 30 class II and III obese patients as a control group (Cont), consisting of daily dietary intake of macronutrients, calcium and sodium, serum 25(OH)D and parathyroid hormone (PTH) and other biochemical serum and urinary parameters. Bone alkaline phosphatase (BAP), leptin, fibroblast growth factor-23 (FGF-23) and deoxypyridinoline (DPYD) were determined from available banked serum and urinary samples. RESULTS Mean body mass index (BMI), median energy, carbohydrate, protein and sodium chloride consumption were significantly lower in the BS versus Cont, but calcium and lipids were not. No significant differences were found in ionized calcium, 25(OH)D, PTH and fibroblast growth factor 23 (FGF-23) between groups. Mean serum BAP was significantly higher for BS versus Cont and had a positive correlation with time after the surgical procedure. Mean serum leptin was significantly lower and median urinary DPYD higher in BS versus Cont. CONCLUSION The present study showed an increase in bone markers of both bone formation and resorption among bariatric patients up to more than 7 years after the surgical procedure, suggesting that an increased bone turnover persists even at a very long-term follow-up in such patients.
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Affiliation(s)
- Thalita Lima Melo
- Disciplina de Nefrologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Leila Froeder
- Disciplina de Nefrologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Leandro da Cunha Baia
- Disciplina de Nefrologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Ita Pfeferman Heilberg
- Disciplina de Nefrologia, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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66
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Cook FJ, Khanna I, Giordano J, Matarese L, Hudson S. LONG-TERM BONE HEALTH AFTER ROUX-EN-Y GASTRIC BYPASS: A PILOT STUDY. Endocr Pract 2017; 23:1077-1084. [PMID: 28683234 DOI: 10.4158/ep171823.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This cross-sectional study was undertaken to assess metabolic bone disease by examining bone mineral density (BMD), fracture prevalence, and nutritional factors pertinent to bone in a cohort >9 years post-Rouxen-Y gastric bypass (RYGB). METHODS Fifty-one subjects 9.4 to 36.0 years (mean 17.0 ± 8.1) post-RYGB provided a focused history. Dietary calcium and protein were assessed. Dual-energy X-ray absorptiometry (DXA) BMD at the spine, hip, and radius and routine serum chemistries, magnesium, phosphorus, parathyroid hormone, vitamin D, vitamin K, and micronutrients were analyzed. Sixteen subjects provided 24-hour urine for measurement of calcium. RESULTS The mean maximum weight loss was 70.3 ± 20 kg (47.4 ± 8.9%), and mean net weight loss was 46.9 ± 23.1 kg (31.2 ± 12.5%). The prevalence rates of fracture, secondary hyperparathyroidism, and vitamin D deficiency were 15.7%, 37%, and 39%, respectively. BMD was in the osteoporotic range in 27.5%. The mean calcium:creatinine clearance ratio was 0.0124 ± 0.0131. Median intakes of dietary calcium, total calcium, protein, and vitamin D were 582.5 mg, 947.5 mg, 50.2 g, and 1,000 IU, respectively. Mean Z-scores at all sites were <0 (P<.01). A negative correlation (P<.05) was noted between distal radius Z-score and net change in BMI. Net change in BMI was greater for those with osteoporosis than those without. (P<.05) Conclusion: Many years after RYGB, BMD remains lower than expected compared to an age-, sex-, race-, and weight-matched reference population and is correlated with the amount of weight lost. Deficiencies of Vitamin D and calcium are prevalent. ABBREVIATIONS BMD = bone mineral density BMI = body mass index Ca:Cr = calcium:creatinine DXA = dual-energy X-ray absorptiometry PTH = parathyroid hormone RYGB = Roux-en-Y gastric bypass UD = ultradistal WHO = World Health Organization.
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67
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Yu EW, Lee MP, Landon JE, Lindeman KG, Kim SC. Fracture Risk After Bariatric Surgery: Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding. J Bone Miner Res 2017; 32:1229-1236. [PMID: 28251687 PMCID: PMC5466471 DOI: 10.1002/jbmr.3101] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/06/2023]
Abstract
The long-term consequences of bariatric surgery on fracture risk are unclear but are likely to vary by procedure type. In physiologic studies, Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) have differential effects on rates of bone loss. Therefore, our objective was to compare fracture risk in obese adults after RYGB and AGB procedures. Using claims data from a US commercial health plan, we analyzed rates of nonvertebral fractures within a propensity score-matched cohort (n = 15,032) of morbidly obese adults who received either RYGB or AGB surgery between 2005 and 2013. A total of 281 nonvertebral fractures occurred during a mean follow-up time of 2.3 ± 1.9 years. RYGB patients had an increased risk of nonvertebral fracture (hazard ratio [HR] = 1.43, 95% confidence interval [CI] 1.13-1.81) compared with AGB patients. In fracture site-specific analyses, RYGB patients had increased risk of fracture at the hip (HR = 1.54, 95% CI 1.03-2.30) and wrist (HR = 1.45, 95% CI 1.01-2.07). Nonvertebral fracture risk associated with RYGB manifested >2 years after surgery and increased in subsequent years, with the highest risk in the fifth year after surgery (HR = 3.91, 95% CI 1.58-9.64). In summary, RYGB is associated with a 43% increased risk of nonvertebral fracture compared with AGB, with risk increasing >2 years after surgery. Fracture risk should be considered in risk/benefit discussions of bariatric surgery, particularly among patients with high baseline risk of osteoporosis who are deciding between RYGB and AGB procedures. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Moa P. Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Joan E. Landon
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Katherine G. Lindeman
- Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Immunology and Allergy; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
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68
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Shanbhogue VV, Støving RK, Frederiksen KH, Hanson S, Brixen K, Gram J, Jørgensen NR, Hansen S. Bone structural changes after gastric bypass surgery evaluated by HR-pQCT: a two-year longitudinal study. Eur J Endocrinol 2017; 176:685-693. [PMID: 28289103 PMCID: PMC5425940 DOI: 10.1530/eje-17-0014] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE, DESIGN AND METHODS Roux-en-Y gastric bypass (RYGB) has proved successful in attaining sustained weight loss but may lead to metabolic bone disease. To assess impact on bone mass and structure, we measured a real bone mineral density at the hip and spine by dual-energy X-ray absorptiometry, and volumetric BMD (vBMD) and bone microarchitecture at the distal radius and tibia by high-resolution peripheral quantitative CT in 25 morbidly obese subjects (15 females, 10 males) at 0, 12 and 24 months after RYGB. Bone turnover markers (BTMs), calciotropic and gut hormones and adipokines were measured at the same time points. RESULTS After a 24.1% mean weight loss from baseline to month 12 (P < 0.001), body weight plateaued from month 12 to 24 (-0.9%, P = 0.50). However, cortical and trabecular vBMD and microarchitecture deteriorated through the 24 months, such that there was a 5 and 7% reduction in estimated bone strength at the radius and tibia respectively (both P < 0.001). The declines observed in the first 12 months were matched or exceeded by declines in the 12- to 24-month period. While a significant increase in BTMs and decrease in leptin and insulin were seen at 24 months, these changes were maximal at month 12 and stabilized from month 12 to 24. CONCLUSIONS Despite weight stabilization and maintenance of metabolic parameters, bone loss and deterioration in bone strength continued and were substantial in the second year. The clinical importance of these changes in terms of increased risk of developing osteoporosis and fragility fractures remain an important concern.
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Affiliation(s)
- Vikram V Shanbhogue
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense C, Denmark
- Correspondence should be addressed to V V Shanbhogue;
| | - René Klinkby Støving
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense C, Denmark
- Center for Eating DisordersOdense University Hospital & Psychiatry of Region Southern Denmark, Odense C, Denmark
| | | | - Stine Hanson
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
| | - Kim Brixen
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense C, Denmark
| | - Jeppe Gram
- Department of EndocrinologyHospital of Southwest Denmark, Esbjerg, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical BiochemistryResearch Center for Ageing and Osteoporosis, Glostrup, Denmark
- OPENOdense Patient data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stinus Hansen
- Department of EndocrinologyOdense University Hospital, Odense C, Denmark
- Institute of Clinical ResearchUniversity of Southern Denmark, Odense C, Denmark
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69
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Hayashi A, Maeda Y, Takemoto M, Tokuyama H, Koide H, Kitahara A, Hayashi H, Kitamoto T, Yamaga M, Kobayashi K, Yokote K. Outcomes of laparoscopic sleeve gastrectomy in elderly obese Japanese patients. Geriatr Gerontol Int 2017; 17:2068-2073. [PMID: 28371292 DOI: 10.1111/ggi.13022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 12/29/2016] [Accepted: 01/17/2017] [Indexed: 12/28/2022]
Abstract
AIM Laparoscopic sleeve gastrectomy (LSG) has proven to be the most effective strategy for the treatment of morbid obesity, however its efficacy and safety in an aging population has not yet been confirmed. In this study, we evaluated the effectiveness and safety of LSG in elderly obese Japanese patients. METHODS Three obese individuals aged >60 years and 11 obese individuals aged <60 years who underwent LSG were enrolled. Pre- and postoperative changes after at least 12 months were examined, including bodyweight, body mass index, total weight loss, excess weight loss, bone mineral density and bone-related markers. RESULTS There were no significant differences between patients aged <60 years and >60 years in terms of percent total weight loss (24.4 ± 11 vs 23 ± 4.4%, respectively) and percent excess weight loss (49.1 ± 23.4 vs 47.6 ± 10 %, respectively). Dual-energy X-ray absorptiometry was carried out before and 12 months after LSG. There were no significant differences in bone mineral density changes at the lumbar spine and femoral neck between the two groups (0.01 ± 0.06 vs 0.02 ± 0.03 g/cm2 , -0.03 ± 0.06 vs -0.08 ± 0.02 g/cm2 , respectively). There were no peri- and postoperative complications. All three patients aged >60 years had reduced bone mineral density in the femoral neck after LSG; one was diagnosed with osteoporosis. CONCLUSIONS Although the present results suggest that LSG could be of considerable benefit to elderly obese Japanese patients, long-term careful observation after bariatric surgery is especially important in elderly patients to prevent future osteoporosis. Geriatr Gerontol Int 2017; 17: 2068-2073.
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Affiliation(s)
- Aiko Hayashi
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yukari Maeda
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Minoru Takemoto
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hirotake Tokuyama
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Yu-karigaoka Tokuyama Clinic, Chiba, Japan
| | - Hisashi Koide
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Aya Kitahara
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hideki Hayashi
- Department of Frontier Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takumi Kitamoto
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masaya Yamaga
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Kazuki Kobayashi
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Kokuho Asahi-chuo hospital, Chiba, Japan
| | - Koutaro Yokote
- Department of Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.,Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
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70
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Abstract
Most metabolic effects following bariatric surgery are favorable. One area in which the consequences seem to be detrimental is on skeletal health. Mechanisms that have been cited include malabsorption of calcium and vitamin D, decrease in mechanical loading, and changes in gastrointestinal and fat-derived hormone levels. It is important that the impact of these procedures on bone metabolism is closely examined. The significance of the bone loss that occurs, and its possible effect on future fracture risk, should also be evaluated.
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Affiliation(s)
- Naina Sinha Gregory
- Division of Endocrinology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medical College, 211 East 80th Street, New York, NY 10075, USA.
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71
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Carrelli A, Bucovsky M, Horst R, Cremers S, Zhang C, Bessler M, Schrope B, Evanko J, Blanco J, Silverberg SJ, Stein EM. Vitamin D Storage in Adipose Tissue of Obese and Normal Weight Women. J Bone Miner Res 2017; 32:237-242. [PMID: 27542960 PMCID: PMC5577589 DOI: 10.1002/jbmr.2979] [Citation(s) in RCA: 116] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 11/10/2022]
Abstract
Although vitamin D deficiency is prevalent among obese individuals, its cause is poorly understood. Few studies have measured vitamin D concentrations in adipose of obese (OB) subjects, and none have included normal weight controls (C). The goal of this study was to investigate whether the relationship between body composition, serum 25-hydroxyvitamin D (25OHD), vitamin D in subcutaneous (SQ) and omental (OM) adipose, and total adipose stores of vitamin D differ among OB and C. Obese women undergoing bariatric surgery and normal-weight women undergoing abdominal surgery for benign gynecologic conditions were enrolled. Subjects had measurements of serum 25OHD by high-performance liquid chromatography (HPLC) and body composition by dual-energy X-ray absorptiometry (DXA). Vitamin D concentrations in SQ and OM adipose were measured by mass spectroscopy. Thirty-six women were enrolled. Serum 25OHD was similar between groups (OB 27 ± 2 versus C 26 ± 2 ng/mL; p = 0.71). Adipose vitamin D concentrations were not significantly different in either SQ (OB 34 ± 9 versus C 26 ± 12 ng/g; p = 0.63) or OM compartments (OB 51 ± 13 versus C 30 ± 18 ng/g; p = 0.37). The distribution of vitamin D between SQ and OM compartments was similar between groups. Serum 25OHD was directly related to adipose vitamin D in both groups. Total body vitamin D stores were significantly greater in OB than in C (2.3 ± 0.6 versus 0.4 ± 0.8 mg, respectively; p < 0.01). In summary, although OB had significantly greater total vitamin D stores than C, the relationship between serum 25OHD and fat vitamin D and the overall pattern of distribution of vitamin D between the OM and SQ fat compartments was similar. Our data demonstrate that obese subjects have greater adipose stores of vitamin D. They support the hypotheses that the enlarged adipose mass in obese individuals serves as a reservoir for vitamin D and that the increased amount of vitamin D required to saturate this depot may predispose obese individuals to inadequate serum 25OHD. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Angela Carrelli
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Mariana Bucovsky
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | - Serge Cremers
- Departments of Pathology & Cell Biology and Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Chengchen Zhang
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Marc Bessler
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Beth Schrope
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - John Evanko
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Jody Blanco
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Shonni J Silverberg
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Emily M Stein
- Division of Endocrinology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
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72
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Lespessailles E, Toumi H. Vitamin D alteration associated with obesity and bariatric surgery. Exp Biol Med (Maywood) 2017; 242:1086-1094. [PMID: 28103699 DOI: 10.1177/1535370216688567] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries. Interactions and relationships between obesity and bone tissue and its metabolism are complex but are more and more studied and recognized. Obesity is associated with an altered hormonal profile including particularly bone-regulating hormones like vitamin D. Bariatric surgery procedures, thanks to their effectiveness to achieve therapeutic endpoints for comorbidities associated with obesity, have had an increasing success. However, these surgeries by producing mechanical restriction and or malabsorption syndrome lead to nutritional deficiencies including vitamin D. In this review, we aim to (1) discuss the nutritional deficiency of vitamin D in the obese, (2) to summarize the different surgical options in bariatric surgery and to present the evidence concerning these procedures and their associated profile in vitamin D post-operative insufficiency, (3) to present the different recommendations in clinical practice to prevent or treat vitamin D deficiencies or insufficiencies in patients treated by bariatric surgery and finally to introduce emerging assumptions on the relationship between vitamin D, microbiota composition and circulating bile acids. Impact statement Obesity and severe obesity constitute growing serious health problems reaching epidemic proportion in most countries with a prevalence increasing from 6.4 in 1975 to 14.9% in 2014. This present review summarizes currently available data on vitamin D deficiencies in the obese population before and after bariatric surgery. The important evidence emerging from our evaluation confirms that obese patients are at risk of multiple nutritional deficiencies, especially vitamin D deficiency, before bariatric surgery. Our survey confirms that the precise role of the gut microbiome and its associated changes on the vitamin D metabolism after the different bariatric surgery procedures has not yet been studied. Furthermore, whether differences in the microbiota may alter the therapeutic responses to vitamin D is not known.
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Affiliation(s)
- Eric Lespessailles
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
| | - Hechmi Toumi
- 1 Univ. Orleans, I3MTO Laboratory EA 4708, Orleans 45067, France.,2 Rheumatology Department, Hospital Orleans, Orleans 45067, France
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73
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Murchison R, Gooday C, Dhatariya K. The development of a charcot foot after significant weight loss in people with diabetes: three cautionary tales. J Am Podiatr Med Assoc 2016; 104:522-5. [PMID: 25275743 DOI: 10.7547/0003-0538-104.5.522] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Medication to aid weight loss and weight loss surgery are becoming more commonly available for people with diabetes. As a result of profound weight loss, diabetes may go into remission and many biochemical and physical parameters improve. However, some of the end organ damage associated with diabetes may not improve, peripheral neuropathy being an example. We present three cases in people with diabetes and pre-existing peripheral neuropathy who had lost significant weight. They became more mobile and developed a Charcot foot despite their diabetes improving significantly. People who have lost significant weight should continue to monitor their feet because the risks of foot disease remain even if diabetes goes into remission.
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Affiliation(s)
- Rachel Murchison
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, England
| | - Catherine Gooday
- Diabetic Foot Clinic, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, England
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74
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Maghsoodi N, Alaghband-Zadeh J, Cross GF, Werling M, Fändriks L, Docherty NG, Olbers T, Dew T, Sherwood RA, Vincent RP, le Roux CW. Elevated fasting and postprandial C-terminal telopeptide after Roux-en-Y gastric bypass. Ann Clin Biochem 2016; 54:495-500. [DOI: 10.1177/0004563216667964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Roux-en-Y gastric bypass increases circulating bile acid concentrations, known mediators of postprandial suppression of markers of bone resorption. Long-term data, however, indicate that Roux-en-Y gastric bypass confers an increased risk of bone loss on recipients. Methods Thirty-six obese individuals, median age 44 (26–64) with median body mass index at baseline of 42.5 (40.4–46) were studied before and 15 months after Roux-en-Y gastric bypass. After an overnight fast, patients received a 400 kcal mixed meal. Blood samples were collected premeal then at 30-min periods for 120 min. Pre and postmeal samples were analysed for total bile acids, parathyroid hormone and C-terminal telopeptide. Results Body weight loss post Roux-en-Y gastric bypass was associated with a median 4.9-fold increase in peak postprandial total bile acid concentration, and a median 2.4-fold increase in cumulative food evoked bile acid response. Median fasting parathyroid hormone, postprandial reduction in parathyroid hormone and total parathyroid hormone release over 120 min remained unchanged after surgery. After surgery, median fasting C-terminal telopeptide increased 2.3-fold, peak postprandial concentrations increased 3.8-fold and total release was increased 1.9-fold. Conclusions Fasting and postprandial total bile acids and C-terminal telopeptide are increased above reference range after Roux-en-Y gastric bypass. These changes occur in spite of improved vitamin D status with supplementation. These results suggest that post-Roux-en-Y gastric bypass increases in total bile acids do not effectively oppose an ongoing resorptive signal operative along the gut–bone axis. Serial measurement of C-terminal telopeptide may be of value as a risk marker for long-term skeletal pathology in patients post Roux-en-Y gastric bypass.
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Affiliation(s)
- Negar Maghsoodi
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
- Department of Chemical Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | | | - Gemma F Cross
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Malin Werling
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Neil G Docherty
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
| | - Torsten Olbers
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
| | - Tracy Dew
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Roy A Sherwood
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Royce P Vincent
- Department of Clinical Biochemistry, King’s College Hospital NHS Foundation Trust, London, UK
| | - Carel W le Roux
- Department of Gastrosurgical Research and Education, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital/Sahlgrenska, Gothenburg, Sweden
- Diabetes Complications Research Centre, Conway Institute, University College Dublin, Ireland
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75
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Abstract
BACKGROUND The aim is to evaluate via meta-analysis bone metabolism and bone mineral density (BMD) in morbidly obese patients before and after bariatric surgery. METHODS We searched Medline, EMBASE, and the Cochrane Library for relevant studies published before January 2014. The following outcomes were evaluated: serum calcium, serum parathyroid hormone (PTH), serum 25-hydroxyvitamin D [25(OH)D], serum or urinary N-telopeptide (NTX), bone-specific alkaline phosphatase (BSAP), and bone mineral density (BMD). RESULTS Ten studies, including 344 patients, met our inclusion criteria. Results showed a significant decrease in serum calcium (MD = -0.10, 95 %CI -0.14 to -0.07, P < 0.00001) and increase in serum PTH (MD = 12.41, 95 %CI 6.51 to 18.31, P < 0.00001) but no significant difference in serum 25(OH)D (MD = 1.35, 95 %CI -1.12 to 3.83, P = 0.28) following bariatric surgery. There were significant increases in serum or urinary NTX (MD = 18.49, 95 %CI 3.33 to 33.66, P = 0.02) and BSAP (MD = 7.47, 95 %CI 0.21 to 14.72, P = 0.04) but a significant decrease in BMD (MD = -0.08, 95 %CI -0.13 to -0.04, P < 0.00001) after bariatric surgery. CONCLUSION BMD was significantly decreased, while bone turnover was elevated, and bone remodeling was accelerated following bariatric surgery. Basal bone metabolism should be evaluated preoperatively. To prevent secondary hyperparathyroidism and bone loss, calcium and vitamin D should be monitored closely and supplemented accordingly after the surgery.
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Rousseau C, Jean S, Gamache P, Lebel S, Mac-Way F, Biertho L, Michou L, Gagnon C. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ 2016; 354:i3794. [PMID: 27814663 PMCID: PMC4964103 DOI: 10.1136/bmj.i3794] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether bariatric surgery increases the risk of fracture. DESIGN Retrospective nested case-control study. SETTING Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. PARTICIPANTS 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. MAIN OUTCOME MEASURES Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. RESULTS Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for biliopancreatic diversion. CONCLUSIONS Patients undergoing bariatric surgery were more likely to have fractures than were obese or non-obese controls, and this risk remained higher after surgery. Fracture risk was site specific, changing from a pattern associated with obesity to a pattern typical of osteoporosis after surgery. Only biliopancreatic diversion was clearly associated with fracture risk; however, results for Roux-en-Y gastric bypass and sleeve gastrectomy remain inconclusive. Fracture risk assessment and management should be part of bariatric care.
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Affiliation(s)
- Catherine Rousseau
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Sonia Jean
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
- Institut national de santé publique du Québec, Quebec City, Canada, G1V 5B3
| | - Philippe Gamache
- Institut national de santé publique du Québec, Quebec City, Canada, G1V 5B3
| | - Stéfane Lebel
- Quebec Heart and Lung Institute - Laval University, Quebec City, Canada, G1V 4G5
| | - Fabrice Mac-Way
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Laurent Biertho
- Quebec Heart and Lung Institute - Laval University, Quebec City, Canada, G1V 4G5
| | - Laëtitia Michou
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
- Institute of Nutrition and Functional Foods, Quebec City, Canada, G1V 0A6
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77
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Stiehler M, Goronzy J, Günther KP. [Total hip arthroplasty in overweight osteoarthritis patients]. DER ORTHOPADE 2016; 44:523-30. [PMID: 25894514 DOI: 10.1007/s00132-015-3094-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND An increasing number of patients scheduled for total hip arthroplasty (THA) are obese and exhibit a different risk profile from that of patients of normal weight. OBJECTIVES To provide an overview of the impact of obesity on the outcome of primary THA. MATERIALS AND METHODS Literature review and discussion of own epidemiological data. RESULTS Obese patients can expect as much functional improvement as non-obese patients after THA. However, peri- and postoperative complication (e.g., periprosthetic infection and dislocation) rates are reported to be increased in obese THA patients. CONCLUSIONS The knowledge of obesity-associated risks is the prerequiste for successful THA in obese patients.
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Affiliation(s)
- M Stiehler
- UniversitätsCentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland,
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78
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Yu EW, Carmody JS, Brooks DJ, LaJoie S, Kaplan LM, Bouxsein ML. Cortical and trabecular deterioration in mouse models of Roux-en-Y gastric bypass. Bone 2016; 85:23-8. [PMID: 26806052 PMCID: PMC4792678 DOI: 10.1016/j.bone.2016.01.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 01/07/2023]
Abstract
Roux-en-Y gastric bypass (RYGB) is a profoundly effective treatment for severe obesity, but results in significant bone loss in patients. Developing a murine model that recapitulates this skeletal phenotype will provide a robust tool with which to study the physiologic mechanisms of this bone loss. We studied adult male C57BL/6J mice who underwent either RYGB or sham operation. Twelve weeks after surgery, we characterized biochemical bone markers (parathyroid hormone, PTH; C-telopeptide, CTX; and type 1 procollagen, P1NP) and bone microarchitectural parameters as measured by microcomputed tomography. RYGB-treated mice had significant trabecular and cortical bone deficits compared with sham-operated controls. Although adjustment for final body weight eliminated observed cortical differences, the trabecular bone volume fraction remained significantly lower in RYGB mice even after weight adjustment. PTH levels were similar between groups, but RYGB mice had significantly higher indices of bone turnover than sham controls. These data demonstrate that murine models of RYGB recapitulate patterns of bone loss and turnover that have been observed in human clinical studies. Future studies that exploit this murine model will help delineate the alterations in bone metabolism and mechanisms of bone loss after RYGB.
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Affiliation(s)
| | - Jill S. Carmody
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Daniel J. Brooks
- Endocrine Unit, Massachusetts General Hospital
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center
| | - Scott LaJoie
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Lee M. Kaplan
- Obesity, Metabolism, and Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center
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79
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Sakhaee K, Poindexter J, Aguirre C. The effects of bariatric surgery on bone and nephrolithiasis. Bone 2016; 84:1-8. [PMID: 26679435 PMCID: PMC4827266 DOI: 10.1016/j.bone.2015.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/13/2015] [Accepted: 12/04/2015] [Indexed: 12/25/2022]
Abstract
The impact of bariatric surgery on cardiovascular and diabetic complications associated with an improvement in survival has overshadowed the adverse skeletal health and development of kidney stone disease in this population. All longitudinal based studies in the literature reporting the incidence of bone fractures or kidney stones following bariatric surgery were reviewed. Moreover, all publications over the past decade which assessed changes in bone mineral density and bone quality, or explored underlying pathophysiologic mechanisms of bone and kidney stone disease were carefully reviewed. This review provides sufficient data to support that osteoporotic fractures and kidney stone disease are associated with Roux-en-Y gastric bypass surgery. However, due to the limited data available to date, no definitive conclusion could yet be drawn whether sleeve gastrectomy or adjustable gastric banding is associated with bone fractures and kidney stones. Bariatric surgery has emerged as the most effective and sustained treatment for weight reduction. This treatment modality has been recognized to diminish the risk of cardiovascular morbidity and mortality and ameliorate diabetes mellitus complications. The derangement in mineral metabolism has emerged as a major complication following bariatric surgery.
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Affiliation(s)
- Khashayar Sakhaee
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | - John Poindexter
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Crystal Aguirre
- Department of Internal Medicine, Division of Mineral Metabolism, Charles & Jane Pak Center for Mineral Metabolism & Clinical Research,University of Texas Southwestern Medical Center, Dallas, TX, United States
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80
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Frederiksen KD, Hanson S, Hansen S, Brixen K, Gram J, Jørgensen NR, Støving RK. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT. Calcif Tissue Int 2016; 98:253-62. [PMID: 26661530 DOI: 10.1007/s00223-015-0091-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 11/20/2015] [Indexed: 11/27/2022]
Abstract
Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and bone architecture assessed using dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), 6 and 12 months after RYGB, and correlate them to changes in selected biochemical markers. A prospective cohort study included 25 morbidly obese patients (10 males, 15 females). Patients were examined with DXA of the hip and spine, HR-pQCT of radius and tibia, and blood sampling before and 6 and 12 months after RYGB. Patients lost in average 33.5 ± 12.1 kg (25.8 ± 8.5 %) in 12 months. In tibia, we found significant loss of total, cortical and trabecular volumetric BMD after 12 months (all p < 0.001). Microarchitectural changes involved lower trabecular number, increased trabecular separation, and network inhomogeneity along with thinning of the cortex. Estimated bone failure load was decreased after 12 months (p = 0.005). We found only minor changes in radius. Results demonstrate significant alterations of bone microarchitecture suggesting an accelerated endosteal resorption along with disintegration of the trabecular structure which resulted in a loss of estimated bone strength in tibia. Such changes may underlie the recently reported increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.
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Affiliation(s)
- Katrine Diemer Frederiksen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.
| | - Stine Hanson
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
| | - Stinus Hansen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark
| | - Kim Brixen
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
| | - Jeppe Gram
- Department of Endocrinology, Hospital of Southwest Denmark, Finsensgade 35, 6700, Esbjerg, Denmark
| | - Niklas Rye Jørgensen
- Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark
- Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Ndr. Ringvej 57, 2600, Glostrup, Denmark
| | - René Klinkby Støving
- Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark
- Center for Eating Disorders, Odense University Hospital, Kløvervænget 6, 8. sal, 5000, Odense C, Denmark
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81
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Yu EW, Wewalka M, Ding SA, Simonson DC, Foster K, Holst JJ, Vernon A, Goldfine AB, Halperin F. Effects of Gastric Bypass and Gastric Banding on Bone Remodeling in Obese Patients With Type 2 Diabetes. J Clin Endocrinol Metab 2016; 101:714-22. [PMID: 26600045 PMCID: PMC4880129 DOI: 10.1210/jc.2015-3437] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banding (LAGB) or mechanisms underlying bone loss after bariatric surgery. OBJECTIVE To evaluate effects of RYGB and LAGB on fasting and postprandial indices of bone remodeling. DESIGN AND SETTING Ancillary investigation of a prospective study at 2 academic institutions. PARTICIPANTS Obese adults aged 21-65 years with type 2 diabetes who underwent RYGB (n = 11) or LAGB (n = 8). OUTCOMES Serum C-terminal telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and PTH were measured during a mixed meal tolerance test at baseline, 10 days and 1 year after surgery. Changes in 25-hydroxyvitamin D, polypeptide YY (PYY), glucagon-like peptide-1, glucose-dependent insulinotropic peptide, and insulin were also assessed. RESULTS Fasting CTX increased 10 days after RYGB but not LAGB (+69 ± 23% vs +12±12%, P < .001), despite comparable weight loss at that time. By 1 year, fasting CTX and P1NP increased more after RYGB than LAGB (CTX +221 ± 60% vs +15 ± 6%, P<0.001; P1NP +93 ± 25% vs -9 ± 10%, P < .001) and weight loss was greater with RYGB. Changes in CTX were independent of PTH and 25-hydroxyvitamin D but were associated with increases in fasting PYY. Postprandial suppression of CTX was more pronounced after RYGB than LAGB at 10 days and 1 year postoperatively. CONCLUSIONS RYGB is accompanied by early increases in fasting indices of bone remodeling, independent of weight loss or changes in PTH or 25-hydroxyvitamin D. LAGB did not affect bone markers. PYY and other enterohormonal signals may play a role in RYGB-specific skeletal changes.
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Affiliation(s)
- Elaine W Yu
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Marlene Wewalka
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Su-Ann Ding
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Donald C Simonson
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Kathleen Foster
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Jens J Holst
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Ashley Vernon
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Allison B Goldfine
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Florencia Halperin
- Endocrine Unit (E.W.Y.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114; Research Division (M.W., S.-A.D., K.F., A.B.G.), Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts 02215; Division of Endocrinology (D.C.S., A.B.G., F.H.), Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115; Novo Nordisk Foundation Center for Basic Metabolic Research and Department of Biomedical Sciences (J.J.H.), University of Copenhagen, Denmark; and Center for Metabolic and Bariatric Surgery (A.V.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Worm D, Madsbad S, Kristiansen VB, Naver L, Hansen DL. Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery--a 2-Year Follow-Up Study. Obes Surg 2015; 25:1647-52. [PMID: 25585613 DOI: 10.1007/s11695-014-1568-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Concerns regarding nutritional deficiencies have recently emerged after Roux-en-Y gastric bypass (RYGB). METHODS A total of 835 subjects underwent RYGB, age 43.3 years, body mass index (BMI) 47.2 kg/m(2). Hematological and calcium metabolic variables were measured before, 6, 12, and 24 months after surgery. Daily supplement of 800 mg calcium, 800 U vitamin D, a multivitamin, and a vitamin B12 injection (1 mg) every third month was recommended. In subjects with low ferritin and decreasing hemoglobin levels, oral, or intravenous iron was administered. RESULTS Hemoglobin concentration decreased from before surgery to month 24 for both men (9.3 ± 0.05 vs. 8.3 ± 0.08 mmol/L, p < 0.001) and women (8.4 ± 0.03 vs. 7.7 ± 0.06 mmol/L, p < 0.001). At 24 months, anemia was present in 25.8 % of women and 22.1 % of men. Predictors of anemia in both sexes were baseline hemoglobin (p < 0.001), excessive weight loss in men, and younger age in women (p < 0.001). Plasma ferritin levels decreased in both sexes (p < 0.01), whereas concentrations of folic acid and vitamin B12 increased from before surgery to 24 months after surgery (p < 0.001). Vitamin D increased from baseline to month 24 in both sexes (p < 0.01). In women, PTH increased from baseline to month 24 (p < 0.05) with no changes in calcium or magnesium. CONCLUSIONS Supplementation of calcium and vitamin D was sufficient. Iron substitution did not prevent anemia, which especially affected premenopausal women. More attention should be given to iron substitution after RYGB.
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Affiliation(s)
- Dorte Worm
- Department of Internal Medicine, Køge Hospital, Lykkebækvej 1, 4600, Køge, Denmark,
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83
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Maghrabi AH, Wolski K, Abood B, Licata A, Pothier C, Bhatt DL, Nissen S, Brethauer SA, Kirwan JP, Schauer PR, Kashyap SR. Two-year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy. Obesity (Silver Spring) 2015; 23:2344-8. [PMID: 26193177 PMCID: PMC4701611 DOI: 10.1002/oby.21150] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/20/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the 2-year outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) vs. intensive medical therapy (IMT) on lean body mass, total bone mass, and bone mineral density (BMD) measures from the STAMPEDE trial. METHODS 54 subjects (BMI: 36 ± 1 kg/m(2) , age: 48 ± 4 years) with type 2 diabetes (T2DM) (HbA1c : 9.7 ± 2%) were randomized to IMT, RYGB, or SG and underwent DXA at baseline and at 1 and 2 years. RESULTS At 2 years, the reduction in BMI was similar after RYGB and SG and was greater than IMT (P < 0.001). Lean mass was reduced by ∼10%, total bone mineral content reduced by ∼8%, and hip BMD reduced by ∼9% in both surgical groups and was significantly greater than IMT despite increases in vitamin D intake in all groups. The change in hip BMD correlated with weight loss (r = 0.84, P < 0.0001) and changes in lean mass (r = 0.74, P < 0.0001) and leptin (r = 0.53, P < 0.0001). Peripheral fractures were self-reported in RYGB (4/18 patients), SG (2/19 patients), and IMT (4/16 patients). CONCLUSIONS Surgically induced weight loss is associated with modest reductions in lean mass, bone mineral content, and BMD, despite calcium and vitamin D supplementation in patients with T2DM. Awareness for bone loss is indicated for patients undergoing bariatric procedures.
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Affiliation(s)
- Adam H Maghrabi
- Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA
| | - Kathy Wolski
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Beth Abood
- Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA
| | - Angelo Licata
- Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA
| | - Claire Pothier
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | - Deepak L Bhatt
- Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Steven Nissen
- Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio
| | | | | | - Philip R Schauer
- Bariatric and Metabolic Institute, The Cleveland Clinic, Ohio, USA
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Lu CW, Chang YK, Chang HH, Kuo CS, Huang CT, Hsu CC, Huang KC. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore) 2015; 94:e2087. [PMID: 26632892 PMCID: PMC4674195 DOI: 10.1097/md.0000000000002087] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric surgery on the risk of fractures.
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Affiliation(s)
- Chia-Wen Lu
- From the Department of Family Medicine, National Taiwan University Hospital, Taipei (C-WL, H-HC, C-SK, K-CH); Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County (Y-KC, C-TH, C-CH, K-CH); Department of Family Medicine, College of Medicine, National Taiwan University, Taipei (K-CH); Department of Health Services Administration, China Medical University, Taichung City (C-CH); and Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (C-CH)
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Adamczyk P, Bužga M, Holéczy P, Švagera Z, Šmajstrla V, Zonča P, Pluskiewicz W. Bone mineral density and body composition after laparoscopic sleeve gastrectomy in men: A short-term longitudinal study. Int J Surg 2015; 23:101-7. [PMID: 26408948 DOI: 10.1016/j.ijsu.2015.09.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Longitudinal changes in bone and body composition occurring in obese men after laparoscopic sleeve gastrectomy (LSG) has been evaluated. METHODS In short-term longitudinal study, 25 obese men in mean baseline age 44.8 ± 10.9 years and mean body mass index (BMI) 43.3 ± 4.4 kg/m(2)were assessed after undergoing LSG for obesity. Bone mineral density (BMD) (spine, femoral neck [FN], total hip [TH], and total body [TB]) and body composition (TB bone mineral content [BMC], fat, % of fat, lean, lean BMC, total mass) were assessed at baseline, and after three and six months. RESULTS Mean body measurements, including weight, BMI, waist and hips, decreased significantly over the study period (p < 0.0001). FN BMD (p < 0.01) and TH BMD (p < 0.001) decreased, and spine BMD increased significantly (p < 0.001). TB BMD did not change. Weight decreased by 21.3 ± 7.3%, BMI by 21.2 ± 7.3%, FN BMD by 3.32 ± 6.35%, TH BMD by 3.51 ± 3.95% whereas spine BMD increased by 2.89 ± 5.1%. TB BMC increased by 2.4 ± 4.62%; all other variables relating to body composition decreased: fat by 33.0 ± 9.6%, lean mass by 12.8 ± 6.1%, lean BMC by 12.3 ± 5.9%, total mass by 20.1 ± 6.4%, and % fat by 15.8 ± 7.2%. CONCLUSIONS After LSG, body size and variables related to body composition (except for TB BMC) decreased with an accompanying decrease in FN BMD in the men in this study. Spine BMD increased, and TB BMD did not change.
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Affiliation(s)
- Piotr Adamczyk
- Chair and Clinical Department of Pediatrics, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Marek Bužga
- University of Ostrava, Department of Physiology, Medical Faculty, Ostrava, Czech Republic
| | - Pavol Holéczy
- University of Ostrava, Department of Surgical Disciplines, Medical Faculty, Czech Republic
| | - Zdeněk Švagera
- University of Ostrava, Department of Biomedical Sciences, Faculty of Medicine, Ostrava, Czech Republic
| | - Vít Šmajstrla
- Bone Densitometry Laboratory, Bormed, Ostrava, Czech Republic
| | - Pavel Zonča
- University of Ostrava, Department of Surgical Disciplines, Medical Faculty, Czech Republic
| | - Wojciech Pluskiewicz
- Chair of Internal Medicine, Diabetology and Nephrology, Metabolic Bone Diseases Unit, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland.
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Gaudio A, Muratore F, Fiore V, Rapisarda R, Signorelli SS, Fiore CE. Decreased bone cortical density at the forearm in subjects with subclinical peripheral arterial disease. Osteoporos Int 2015; 26:1747-53. [PMID: 25672808 DOI: 10.1007/s00198-015-3057-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED The association between peripheral arterial disease (PAD) and low bone mass is controversial. In our study, peripheral quantitative computed tomography shows a reduction of cortical but not trabecular, bone mineral density (BMD) at the forearm, in patients with subclinical PAD. INTRODUCTION Some controversy exists regarding the association between peripheral arterial disease (PAD) and low bone mass. Previous studies have evaluated bone mineral density (BMD) in patients with subclinical PAD, with mixed results. Inconsistency of data may depend on the fact that most studies measured areal bone mineral density (aBMD) by Dual-energy-x ray absorptiometry (DXA). Because DXA cannot distinguish between cortical and trabecular compartments, we reasoned that a study aimed to establish whether these compartments were differentially affected by PAD status could give more information on the nature of this association. METHODS In this cross-sectional study, we used peripheral quantitative computed tomography (pQCT) to examine volumetric cortical and trabecular mineral density at the radius (vBMD) in a cohort of subjects with subclinical PAD as defined by ABI ≤0.90 and compared them with healthy subjects with no evidence of PAD. RESULTS Patients with subclinical PAD had significantly reduced cortical density (1101.0 ± 45.4 vs 1156.2 ± 51.3 mg/cm(3), p < 0.001) and cortical area (75.0 ± 20.9 vs 99.9 ± 18.2 mm(2), p < 0.001) than healthy subjects. Trabecular density (178.1 ± 47.9 vs 165.8 ± 29.6 mg/cm(3)) was not significantly different in the two groups. CONCLUSION Subclinical PAD induces a selective bone loss at the radius compartment, not identified by standard DXA, which seems to occur primarily at the cortical level.
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Affiliation(s)
- A Gaudio
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - F Muratore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - V Fiore
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - R Rapisarda
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - S S Signorelli
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - C E Fiore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy.
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Spatz JM, Wein MN, Gooi JH, Qu Y, Garr JL, Liu S, Barry KJ, Uda Y, Lai F, Dedic C, Balcells-Camps M, Kronenberg HM, Babij P, Pajevic PD. The Wnt Inhibitor Sclerostin Is Up-regulated by Mechanical Unloading in Osteocytes in Vitro. J Biol Chem 2015; 290:16744-58. [PMID: 25953900 DOI: 10.1074/jbc.m114.628313] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Indexed: 11/06/2022] Open
Abstract
Although bone responds to its mechanical environment, the cellular and molecular mechanisms underlying the response of the skeleton to mechanical unloading are not completely understood. Osteocytes are the most abundant but least understood cells in bones and are thought to be responsible for sensing stresses and strains in bone. Sclerostin, a product of the SOST gene, is produced postnatally primarily by osteocytes and is a negative regulator of bone formation. Recent studies show that SOST is mechanically regulated at both the mRNA and protein levels. During prolonged bed rest and immobilization, circulating sclerostin increases both in humans and in animal models, and its increase is associated with a decrease in parathyroid hormone. To investigate whether SOST/sclerostin up-regulation in mechanical unloading is a cell-autonomous response or a hormonal response to decreased parathyroid hormone levels, we subjected osteocytes to an in vitro unloading environment achieved by the NASA rotating wall vessel system. To perform these studies, we generated a novel osteocytic cell line (Ocy454) that produces high levels of SOST/sclerostin at early time points and in the absence of differentiation factors. Importantly, these osteocytes recapitulated the in vivo response to mechanical unloading with increased expression of SOST (3.4 ± 1.9-fold, p < 0.001), sclerostin (4.7 ± 0.1-fold, p < 0.001), and the receptor activator of nuclear factor κΒ ligand (RANKL)/osteoprotegerin (OPG) (2.5 ± 0.7-fold, p < 0.001) ratio. These data demonstrate for the first time a cell-autonomous increase in SOST/sclerostin and RANKL/OPG ratio in the setting of unloading. Thus, targeted osteocyte therapies could hold promise as novel osteoporosis and disuse-induced bone loss treatments by directly modulating the mechanosensing cells in bone.
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Affiliation(s)
- Jordan M Spatz
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, Harvard-MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Marc N Wein
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Jonathan H Gooi
- NorthWest Academic Centre, The University of Melbourne, St. Albans, Victoria 3065, Australia, and
| | - Yili Qu
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Jenna L Garr
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Shawn Liu
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Kevin J Barry
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Yuhei Uda
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Forest Lai
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Christopher Dedic
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | - Mercedes Balcells-Camps
- Harvard-MIT Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, Bioengineering Department, Institut Quimic de Sarria, Ramon Llull University, 08017 Barcelona, Spain
| | - Henry M Kronenberg
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114
| | | | - Paola Divieti Pajevic
- From the Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114,
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Yu EW, Bouxsein ML, Putman MS, Monis EL, Roy AE, Pratt JSA, Butsch WS, Finkelstein JS. Two-year changes in bone density after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab 2015; 100:1452-9. [PMID: 25646793 PMCID: PMC4399296 DOI: 10.1210/jc.2014-4341] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Bariatric surgery is increasingly popular but may lead to metabolic bone disease. OBJECTIVE The objective was to determine the rate of bone loss in the 24 months after Roux-en-Y gastric bypass. DESIGN AND SETTING This was a prospective cohort study conducted at an academic medical center. PARTICIPANTS The participants were adults with severe obesity, including 30 adults undergoing gastric bypass and 20 nonsurgical controls. OUTCOMES We measured bone mineral density (BMD) at the lumbar spine and proximal femur by quantitative computed tomography (QCT) and dual-energy x-ray absorptiometry at 0, 12, and 24 months. BMD and bone microarchitecture were also assessed by high-resolution peripheral QCT, and estimated bone strength was calculated using microfinite element analysis. RESULTS Weight loss plateaued 6 months after gastric bypass but remained greater than controls at 24 months (-37 ± 3 vs -5 ± 3 kg [ mean ± SEM]; P < .001). At 24 months, BMD was 5-7% lower at the spine and 6-10% lower at the hip in subjects who underwent gastric bypass compared with nonsurgical controls, as assessed by QCT and dual-energy x-ray absorptiometry (P < .001 for all). Despite significant bone loss, average T-scores remained in the normal range 24 months after gastric bypass. Cortical and trabecular BMD and microarchitecture at the distal radius and tibia deteriorated in the gastric bypass group throughout the 24 months, such that estimated bone strength was 9% lower than controls. The decline in BMD persisted beyond the first year, with rates of bone loss exceeding controls throughout the second year at all skeletal sites. Mean serum calcium, 25(OH)-vitamin D, and PTH were maintained within the normal range in both groups. CONCLUSIONS Substantial bone loss occurs throughout the 24 months after gastric bypass despite weight stability in the second year. Although the benefits of gastric bypass surgery are well established, the potential for adverse effects on skeletal integrity remains an important concern.
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Affiliation(s)
- Elaine W Yu
- Endocrine Unit (E.W.Y., M.L.B., M.S.P., E.L.M., A.E.R., J.S.F.), and Weight Center (J.S.A.P., W.S.B.), Massachusetts General Hospital, Boston, Massachusetts 02114
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Nishiyama KK, Pauchard Y, Nikkel LE, Iyer S, Zhang C, McMahon DJ, Cohen D, Boyd SK, Shane E, Nickolas TL. Longitudinal HR-pQCT and image registration detects endocortical bone loss in kidney transplantation patients. J Bone Miner Res 2015; 30:554-61. [PMID: 25213758 DOI: 10.1002/jbmr.2358] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/21/2014] [Accepted: 09/07/2014] [Indexed: 11/07/2022]
Abstract
Patients with chronic kidney disease (CKD) who undergo kidney transplantation experience bone loss and increased risk of fracture. However, the mechanisms of this bone loss are unclear. Our objective was to use image registration to define the cortex to assess changes in cortical porosity (Ct.Po) in patients undergoing first-time kidney transplantation. We obtained serial measurements of parathyroid hormone (PTH) and bone turnover markers and used high-resolution peripheral quantitative computed tomography (HR-pQCT) to scan the distal radius and tibia in 31 patients (21 men, 10 women; aged 51.9 ± 13.4 years) at transplant and after 1 year. Baseline and 1-year images were aligned using a fully automated, intensity-based image registration framework. We compared three methods to define the cortical region of interest (ROI) and quantify the changes: 1) cortical bone was independently defined in baseline and follow-up scans; 2) cortical bone was defined as the common cortical ROI; and 3) the cortical ROI at baseline was carried forward to 1-year follow-up (baseline-indexed). By the independently defined ROI, Ct.Po increased 11.7% at the radius and 9.1% at the tibia, whereas by the common ROI, Ct.Po increased 14.6% at the radius and 9.1% at the tibia. By the baseline-indexed ROI, which provides insight into changes at the endocortical region, Ct.Po increased 63.4% at the radius and 17.6% at the tibia. We found significant relationships between changes in Ct.Po and bone formation and resorption markers at the radius. The strongest associations were found between markers and Ct.Po using the baseline-index method. We conclude that Ct.Po increases throughout the cortex after kidney transplant, and this increase is particularly marked at the endocortical surface. These methods may prove useful for all HR-pQCT longitudinal studies, particularly when changes are expected at the endocortical region.
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90
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Fernando HA, Zibellini J, Hsu MS, Seimon RV, Nguyen AD, Sainsbury A. The neuropeptide Y-ergic system: potential therapeutic target against bone loss with obesity treatments. Expert Rev Endocrinol Metab 2015; 10:177-191. [PMID: 30293515 DOI: 10.1586/17446651.2015.1001741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Obesity is no longer considered to provide protection against osteoporosis. Moreover, treatments for obesity are now suspected of reducing bone mass. With the escalating incidence of obesity, combined with increases in the frequency, duration and intensity of interventions used to combat it, we face a potential increase in health burden due to osteoporotic fractures. The neuropeptide Y-ergic system offers a potential target for the prevention and anabolic treatment of bone loss in obesity, due to its dual role in the regulation of energy homeostasis and bone mass. Although the strongest stimulation of bone mass by this system appears to occur via indirect hypothalamic pathways involving Y2 receptors (one of the five types of receptors for neuropeptide Y), Y1 receptors on osteoblasts (bone-forming cells) induce direct effects to enhance bone mass. This latter pathway may offer a suitable target for anti-osteoporotic treatment while also minimizing the risk of adverse side effects.
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Affiliation(s)
- Hamish A Fernando
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Jessica Zibellini
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Michelle Sh Hsu
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Radhika V Seimon
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
| | - Amy D Nguyen
- b 2 Neuroscience Program, Garvan Institute of Medical Research, University of New South Wales, Darlinghurst, Australia
| | - Amanda Sainsbury
- a 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown NSW 2006, Australia
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Muschitz C, Kocijan R, Marterer C, Nia AR, Muschitz GK, Resch H, Pietschmann P. Sclerostin levels and changes in bone metabolism after bariatric surgery. J Clin Endocrinol Metab 2015; 100:891-901. [PMID: 25490275 DOI: 10.1210/jc.2014-3367] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CONTEXT The role of sclerostin as a key regulator of bone formation remains unknown after Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (SG). OBJECTIVES The study objectives were evaluation of sclerostin and Dickkopf-1 (DKK-1) serum levels after surgery and correlations with bone turnover markers (P1NP, CTX), parathyroid hormone (iPTH) and areal bone mineral density (BMD), changes at total body, lumbar spine and total hip. DESIGN AND SETTING This was a prospective observational single-center two-arm study in premenopausal women with acute adipositas over 24 months. PARTICIPANTS Participants were 52 premenopausal women (40 ± 8 years, BMI 43.4) after RYGB and 38 premenopausal women (41 ± 7 years, BMI 45.7) after SG. MAIN OUTCOME MEASURES Prior to surgery and 1, 3, 6, 9, 12, 18, and 24 months after surgery sclerostin, DKK-1, CTX, P1NP levels and BMD were measured. RESULTS Sclerostin, CTX and (to a lesser extent) P1NP increased after surgery and remained elevated during the entire study period (P < 0.001). DKK-1 declined during months 3-9 (P < 0.005) and then remained unchanged, serum phosphate continuously increased (P < 0.001), iPTH remained within the upper normal limit. Sclerostin increases were significantly positively correlated with CTX and P1NP increases and negatively correlated with BMD loss. BMD independently declined regardless of RYGB and SG. Elevations of sclerostin, CTX, P1NP, and phosphate, but not DKK-1 and iPTH, were significant discriminating factors for BMD loss (AUC 0.920). CONCLUSION Rapid and sustained increases of sclerostin, CTX, and to a lesser extent, P1NP cause an increase in bone metabolism and result in BMD loss at all skeletal sites.
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Affiliation(s)
- Christian Muschitz
- St Vincent Hospital, Medical Department II (C.M., R.K., C.M., A.R.N., H.R.), Academic Teaching Hospital of Medical University of Vienna, Stumpergasse 13, Vienna, Austria; Division of Plastic and Reconstructive Surgery, Department of Surgery (G.K.M.), Medical University of Vienna, Vienna, Austria; Department of Pathophysiology and Allergy Research (P.P.), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna. Vienna, Austria
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Scibora LM. Skeletal effects of bariatric surgery: examining bone loss, potential mechanisms and clinical relevance. Diabetes Obes Metab 2014; 16:1204-13. [PMID: 25132010 DOI: 10.1111/dom.12363] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/27/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023]
Abstract
Bariatric surgery is the most effective therapeutic approach to morbid obesity, resulting in substantial weight loss and improved cardiometabolic profiles; however, a growing body of evidence suggests that bariatric procedures increase both skeletal fragility and the risk of related future fracture secondary to excessive bone loss. Prospective evidence shows that areal bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA) declines by as much as 14% in the proximal femoral regions, including the femoral neck and total hip, 12 months postoperatively. Lumbar spine areal BMD outcomes show greater 12-month postoperative variability across surgical procedures (-8 to +6%) and contrast with no change in volumetric BMD outcomes measured by quantitative computed tomography. Diminished mechanical loading, micronutrient deficiency and malabsorption, along with neurohormonal alterations, offer plausible underlying mechanisms to explain these observed post-bariatric bone changes, but most remain largely unsubstantiated in this population. Importantly, DXA-based skeletal imaging may have limited utility in accurately detecting bone change in people undergoing bariatric surgery; partly because excessive tissue overlying bone increases the variability of areal BMD outcomes. Moreover, a paucity of fracture and osteoporosis incidence data raises questions about whether marked post-bariatric surgery bone loss is clinically relevant or a functional adaptation to skeletal unloading. Future studies that use technology which is able to accurately capture the site-specific volumetric BMD and bone architectural changes that underpin bone strength in people undergoing bariatric surgery, that consider mechanical load, and that better quantify long-term fracture and osteoporosis incidence are necessary to understand the actual skeletal effects of bariatric surgery.
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Affiliation(s)
- L M Scibora
- Health and Human Performance Department, University of St. Thomas, St. Paul, MN, USA
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Serum 25-Hydroxyvitamin D Levels After Bariatric Surgery. Clin Rev Bone Miner Metab 2014. [DOI: 10.1007/s12018-014-9172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Werth S, Kamvissi V, Stange T, Kuhlisch E, Weiss N, Beyer-Westendorf J. Outpatient or inpatient treatment for acute pulmonary embolism: a retrospective cohort study of 439 consecutive patients. J Thromb Thrombolysis 2014; 40:26-36. [DOI: 10.1007/s11239-014-1141-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Extreme obesity is defined by the Centers for Disease Control and Prevention as a body mass index (BMI) higher than 120% of the 95th percentile for age. Four to six percent of American youths fall into this subcategory and are at increased risk for developing comorbidities, including hypertension, dyslipidemia, nonalcoholic fatty liver disease, insulin resistance, sleep apnea, and bone and joint problems. Many studies have shown that nonsurgical treatment programs do not provide significant long-term improvements in BMI in adolescents with severe obesity. In adults, bariatric (weight loss) surgery has been shown to dramatically reduce BMI and to reverse or prevent many complications of obesity; thus, bariatric surgery is being used in an attempt to reverse clinically severe obesity in adolescents. This review highlights the indications for bariatric surgery in adolescents and outlines practice guidelines for adolescent surgical weight loss programs. The authors summarize available data on the effects of adolescent weight loss surgery on metabolic comorbidities and highlight the important acute and long-term complications that must be monitored by their general pediatricians. After reading this article, the general pediatrician should be able to identify adolescents who may be candidates for weight loss surgery and have the knowledge to assist in their postoperative medical management.
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Rodríguez-Carmona Y, López-Alavez FJ, González-Garay AG, Solís-Galicia C, Meléndez G, Serralde-Zúñiga AE. Bone mineral density after bariatric surgery. A systematic review. Int J Surg 2014; 12:976-82. [PMID: 25110331 DOI: 10.1016/j.ijsu.2014.08.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 07/19/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Bone regulation system may be affected after bariatric surgeries, but procedures impact differently to bone mineral density (BMD) and measures restraining bone loss are frequently neglected until clinical consequences become manifest. This is a systematic review aimed to elucidate whether BMD loss is comparable after different bariatric surgeries. MATERIALS AND METHODS A search of morbid obese adults, undergone to bariatric surgery, with BMD measured by dual-energy X-ray absorptiometry at baseline and after surgery studies was performed in several databases. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and COCHRANE Risk of Bias tool. The random model was selected for meta-analysis; heterogeneity was analyzed with T(2), inconsistency (I(2) > 50%) and Chi(2) (p < 0.10). Level of evidence and strength of recommendations were summarized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE System). RESULTS Twelve studies met the selection criteria. After one year, reduction in total BMD in patients with mixed surgical procedures was significant: -0.03 g/cm(2) (CI 95% 0.00 to -0.06, p < 0.05). BMD was reduced by -0.12 g/cm(2) (CI 95% -0.10 to -0.15, p < 0.001) in the hip, -0.07 g/cm(2) (CI 95% -0.03 to -0.11, p < 0.001) in the column, and -0.03 g/cm(2) (IC 95% -0.02 to -0.04, p < 0.001) in the forearm, but not in restrictive surgeries. Studies included showed high heterogeneity and low quality of evidence. CONCLUSIONS Patients undergone to mixed bariatric surgery had significant higher BMD deterioration as demonstrated in this review, suggesting that more attention for preventing fractures is required.
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Affiliation(s)
- Yanelli Rodríguez-Carmona
- Nutrigenetics and Nutrigenomics Laboratory, Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, CP 14610 Mexico City, Mexico.
| | - Francisco J López-Alavez
- Universidad Autónoma Metropolitana Unidad Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, CP 04960 Mexico City, Mexico.
| | - Alejandro G González-Garay
- Department of Research Methodology, Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico.
| | - Cecilia Solís-Galicia
- Instituto Nacional de Pediatría, Insurgentes Sur 3700C, Insurgentes Cuicuilco, Coyoacán, CP 04530 Mexico City, Mexico.
| | - Guillermo Meléndez
- Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148 Col. Doctores, Cuauhtémoc, CP 06726 Mexico City, Mexico.
| | - Aurora E Serralde-Zúñiga
- Clinical Nutrition, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Sección XVI Tlalpan, CP 14000, Mexico City, Mexico.
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Hsin MC, Huang CK, Tai CM, Yeh LR, Kuo HC, Garg A. A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures. Surg Obes Relat Dis 2014; 11:181-5. [PMID: 25701961 DOI: 10.1016/j.soard.2014.07.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/03/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have reported decreased bone mineral density (BMD) after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Laparoscopic adjustable gastric banded plication (LAGBP) is a novel procedure resulting in a dual restrictive mechanism of weight loss without altering gastrointestinal anatomy. The objectives of this study were to compare the BMD changes at 1 year after LAGBP, LSG, and LRYGB. METHODS The sample included 120 patients (40 patients [13 men/27 premenopausal women] each in LAGBP, LSG, and LRYGB groups). The mean preoperative age and body mass index were 30.0±6.5 years and 39.5±3.8 kg/m2, respectively. BMD was measured using dual energy X-ray absorptiometry at the lumbar anteroposterior spine and total hip preoperatively and 1 year postoperatively. RESULTS The mean percentage of excess weight loss was 61.9%±16.8%, 77.1%±12.3%, and 72.7%±17.4% at 1 year after LAGBP, LSG, and LRYGB, respectively. The mean BMD at the lumbar anteroposterior spine remained unchanged in the LSG and LRYGB groups, but significantly increased in the LAGBP group. The mean BMD at the total hip significantly decreased in all groups compared to the preoperative values. However, the mean BMD was significantly higher in the LRYGB than in the LAGBP group. CONCLUSION Bone loss at the hips was observed in all patients, including those with adequate micronutrient supplementation. LRYGB caused significantly greater bone loss than the other procedures.
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Affiliation(s)
- Ming-Che Hsin
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung, Taiwan; Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chih-Kun Huang
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung, Taiwan; Department of General Surgery, E-Da Hospital, Kaohsiung, Taiwan
| | - Chi-Ming Tai
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung, Taiwan
| | - Lee-Ren Yeh
- Department of Radiodiagnosis, E-Da Hospital, Kaohsiung, Taiwan
| | - Hsin-Chih Kuo
- Department of Health Management, I-Shou University, Kaohsiung, Taiwan
| | - Amit Garg
- Bariatric and Metabolic International Surgery Centre, E-Da Hospital, Kaohsiung, Taiwan.
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Yu EW. Bone metabolism after bariatric surgery. J Bone Miner Res 2014; 29:1507-18. [PMID: 24677277 PMCID: PMC4128478 DOI: 10.1002/jbmr.2226] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/07/2014] [Accepted: 03/12/2014] [Indexed: 12/24/2022]
Abstract
Bariatric surgery is a popular and effective treatment for severe obesity but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery.
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Affiliation(s)
- Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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