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de Holanda NCP, Silva TIAR, Cavalcante AG, Lacerda MB, de Oliveira Viena G, de Carvalho CC, Menezes KT, de Medeiros IRN, Sales MM, E Silva de Queiroz FR, de Arruda Castelo Branco Brito CG, Bandeira F. Prevalence of Morphometric Vertebral Fractures After Bariatric Surgery and Its Relationship with Bone Mineral Density and Bone Markers. Obes Surg 2024; 34:733-740. [PMID: 38285298 DOI: 10.1007/s11695-023-07049-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Bariatric surgery (BS) can lead to bone loss and an increased fracture risk. METHODS To determine the morphometric vertebral fracture (MVF) prevalence, and its relationship with bone mineral density (BMD), and biomarker's turnover after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), we analyzed post-surgery X-rays of the spine in 80 patients (88% female, 51% RYGB, age 41.2 [6.8] years) from 117 participants' retrospective cohort (1-2 years, >2 and <5 years, and >5 years). We still analyzed body composition and BMD by dual-energy X-ray absorptiometry and bone parameters. RESULTS MVF prevalence was 17.5% (14/80), with no statistical difference between groups (p = 0.210). RYGB group had a higher prevalence of secondary hyperparathyroidism (SHPT) (PTH ≥ 65 pg/ml; 18.4% vs 7.8%, respectively, p = 0.04), PTH (61.3 vs 49.5 pg/ml, p = 0.001), CTX (0.766 [0.29] ng/ml vs 0.453 [0.30] ng/ml, p = 0.037), and AP (101.3 [62.4] U/L vs 123.9 [60.9] U/L, p = 0.027) than the SG group. Up to 5 years postoperatively, RYGB had a lower total (1.200 [0.087] vs 1.236 [0.100] g/cm2, p = 0.02), femoral neck (1.034 [0.110] vs 1.267 [0.105], p = 0.005), and total femur BMD (1.256 [0.155] vs 1.323 [0.167], p = 0.002) than SG group. We found no statistically significant difference between the MFV (+) and MVF (-) groups regarding age, sex, BMI, surgery time, BMD, or bone and metabolic parameters, including leptin. CONCLUSION We found a high prevalence of MVF after BS with no differences between RYGB and SG.
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Affiliation(s)
- Narriane Chaves Pereira de Holanda
- Department of Endocrinology, Federal University of Paraiba, Joao Pessoa, Brazil.
- Post-Graduation Program in Health Science, University of Pernambuco Medical School, Recife, Brazil.
| | | | | | | | | | | | | | | | | | | | | | - Francisco Bandeira
- Post-Graduation Program in Health Science, University of Pernambuco Medical School, Recife, Brazil
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil
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Herrou J, Mabilleau G, Lecerf JM, Thomas T, Biver E, Paccou J. Narrative Review of Effects of Glucagon-Like Peptide-1 Receptor Agonists on Bone Health in People Living with Obesity. Calcif Tissue Int 2024; 114:86-97. [PMID: 37999750 DOI: 10.1007/s00223-023-01150-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/14/2023] [Indexed: 11/25/2023]
Abstract
Glucagon-like peptide-1 Receptor agonists (GLP-1Ras) such as liraglutide and semaglutide have been recently approved as medications for chronic weight management in people living with obesity (PwO); GLP-1 may enhance bone metabolism and improve bone quality. However, the effects of GLP-1Ras on skeletal health remain to be determined and that's the purpose of this narrative review. Nevertheless, bone consequences of intentional weight loss interventions in PwO are well known: (i) significant weight loss induced by caloric restriction and bariatric surgery results in accelerated bone turnover and bone loss, and (ii) unlike caloric restriction interventions, PwO experience a substantial deterioration in bone microarchitecture and strength associated with an increased risk of fracture after bariatric surgery especially malabsorptive procedures. Liraglutide seems to have a positive effect on bone material properties despite significant weight loss in several rodent models. However, most of positive effects on bone mineral density and microarchitecture were observed at concentration much higher than approved for obesity care in humans. No data have been reported in preclinical models with semaglutide. The current evidence of the effects of GLP-1Ra on bone health in PwO is limited. Indeed, studies on the use of GLP-1Ra mostly included patients with diabetes who were administered a dose used in this condition, did not have adequate bone parameters as primary endpoints, and had short follow-up periods. Further studies are needed to investigate the bone impact of GLP-1Ra, dual- and triple-receptor agonists for GLP-1, glucose-dependent insulin releasing polypeptide (GIP), and glucagon in PwO.
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Affiliation(s)
- Julia Herrou
- Service de Rhumatologie, Inserm U 1153, AP-HP Centre, Hôpital Cochin, Université de Paris, Paris, France
| | - Guillaume Mabilleau
- ONIRIS, Inserm, RMeS, UMR 1229, SFR ICAT, Univ Angers, Nantes Université, Angers, France
| | - Jean-Michel Lecerf
- Department of Nutrition and Physical Activity, Institut Pasteur de Lille, Lille, France
| | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, Centre Hospitalier Universitaire (CHU) Saint-Etienne, Inserm U1059, Lyon University, Saint-Etienne, France
| | - Emmanuel Biver
- Service of Bone Diseases, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Julien Paccou
- Department of Rheumatology, CHU Lille, MABlab ULR 4490, Univ. Lille, 59000, Lille, France.
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3
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Chen R, Armamento-Villareal R. Obesity and Skeletal Fragility. J Clin Endocrinol Metab 2024; 109:e466-e477. [PMID: 37440585 PMCID: PMC10795939 DOI: 10.1210/clinem/dgad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Skeletal fracture has recently emerged as a complication of obesity. Given the normal or better than normal bone mineral density (BMD), the skeletal fragility of these patients appears to be a problem of bone quality rather than quantity. Type 2 diabetes mellitus (T2DM), the incidence of which increases with increasing body mass index, is also associated with an increased risk for fractures despite a normal or high BMD. With the additional bone pathology from diabetes itself, patients with both obesity and T2DM could have a worse skeletal profile. Clinically, however, there are no available methods for identifying those who are at higher risk for fractures or preventing fractures in this subgroup of patients. Weight loss, which is the cornerstone in the management of obesity (with or without T2DM), is also associated with an increased risk of bone loss. This review of the literature will focus on the skeletal manifestations associated with obesity, its interrelationship with the bone defects associated with T2DM, and the available approach to the bone health of patients suffering from obesity.
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Affiliation(s)
- Rui Chen
- Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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4
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Tencerova M, Duque G, Beekman KM, Corsi A, Geurts J, Bisschop PH, Paccou J. The Impact of Interventional Weight Loss on Bone Marrow Adipose Tissue in People Living with Obesity and Its Connection to Bone Metabolism. Nutrients 2023; 15:4601. [PMID: 37960254 PMCID: PMC10650495 DOI: 10.3390/nu15214601] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
This review focuses on providing physicians with insights into the complex relationship between bone marrow adipose tissue (BMAT) and bone health, in the context of weight loss through caloric restriction or metabolic and bariatric surgery (MBS), in people living with obesity (PwO). We summarize the complex relationship between BMAT and bone health, provide an overview of noninvasive imaging techniques to quantify human BMAT, and discuss clinical studies measuring BMAT in PwO before and after weight loss. The relationship between BMAT and bone is subject to variations based on factors such as age, sex, menopausal status, skeletal sites, nutritional status, and metabolic conditions. The Bone Marrow Adiposity Society (BMAS) recommends standardizing imaging protocols to increase comparability across studies and sites, they have identified both water-fat imaging (WFI) and spectroscopy (1H-MRS) as accepted standards for in vivo quantification of BMAT. Clinical studies measuring BMAT in PwO are limited and have shown contradictory results. However, BMAT tends to be higher in patients with the highest visceral adiposity, and inverse associations between BMAT and bone mineral density (BMD) have been consistently found in PwO. Furthermore, BMAT levels tend to decrease after caloric restriction-induced weight loss. Although weight loss was associated with overall fat loss, a reduction in BMAT did not always follow the changes in fat volume in other tissues. The effects of MBS on BMAT are not consistent among the studies, which is at least partly related to the differences in the study population, skeletal site, and duration of the follow-up. Overall, gastric bypass appears to decrease BMAT, particularly in patients with diabetes and postmenopausal women, whereas sleeve gastrectomy appears to increase BMAT. More research is necessary to evaluate changes in BMAT and its connection to bone metabolism, either in PwO or in cases of weight loss through caloric restriction or MBS, to better understand the role of BMAT in this context and determine the local or systemic factors involved.
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Affiliation(s)
- Michaela Tencerova
- Molecular Physiology of Bone, Institute of Physiology of the Czech Academy of Sciences, 14220 Prague, Czech Republic;
| | - Gustavo Duque
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada;
| | - Kerensa M. Beekman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Alessandro Corsi
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy;
| | - Jeroen Geurts
- Rheumatology, Department of Musculoskeletal Medicine, Lausanne University Hospital, 1011 Lausanne, Switzerland;
| | - Peter H. Bisschop
- Department of Endocrinology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Julien Paccou
- Department of Rheumatology, MABLab ULR 4490, CHU Lille, University Lille, 59000 Lille, France
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Maïmoun L, Aouinti S, Puech M, Lefebvre P, Deloze M, de Santa Barbara P, Cristol JP, Brabant S, Gautier T, Nedelcu M, Renard E, Picot MC, Mariano-Goulart D, Nocca D. Effect of Nutritional Deprivation after Sleeve Gastrectomy on Bone Mass, Periostin, Sclerostin and Semaphorin 4D: A Two-Year Longitudinal Study. Nutrients 2023; 15:4310. [PMID: 37892386 PMCID: PMC10610316 DOI: 10.3390/nu15204310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Bariatric surgery induces bone loss, but the exact mechanisms by which this process occurs are not fully known. The aims of this 2-year longitudinal study were to (i) investigate the changes in areal bone mineral density (aBMD) and bone turnover markers following sleeve gastrectomy (SG) and (ii) determine the parameters associated with the aBMD variations. Bone turnover markers, sclerostin, periostin and semaphorin 4D were assessed before and 1, 12 and 24 months after SG, and aBMD was determined by DXA at baseline and after 12 and 24 months in 83 patients with obesity. Bone turnover increased from 1 month, peaked at 12 months and remained elevated at 24 months. Periostin and sclerostin presented only modest increases at 1 month, whereas semaphorin 4D showed increases only at 12 and 24 months. A significant aBMD decrease was observed only at total hip regions at 12 and 24 months. This demineralisation was mainly related to body weight loss. In summary, reduced aBMD was observed after SG in the hip region (mechanical-loading bone sites) due to an increase in bone turnover in favour of bone resorption. Periostin, sclerostin and semaphorin 4D levels varied after SG, showing different time lags, but contrary to weight loss, these biological parameters did not seem to be directly implicated in the skeletal deterioration.
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Affiliation(s)
- Laurent Maïmoun
- Département de Biophysique, Université Montpellier, Service de Médecine Nucléaire, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, CHU de Montpellier, CEDEX 5, 34295 Montpellier, France;
- Physiology and Experimental Medecine of the Heart and Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France;
| | - Safa Aouinti
- Unité de Recherche Clinique et Epidémiologie, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France; (S.A.); (M.-C.P.)
| | - Marion Puech
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHU de Montpellier, 34295 Montpellier, France; (M.P.); (M.D.); (D.N.)
| | - Patrick Lefebvre
- Department of Endocrinology and Diabetes, Lapeyronie Hospital, CHU de Montpellier, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France; (P.L.); (E.R.)
| | - Mélanie Deloze
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHU de Montpellier, 34295 Montpellier, France; (M.P.); (M.D.); (D.N.)
| | - Pascal de Santa Barbara
- Physiology and Experimental Medecine of the Heart and Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France;
| | - Jean-Paul Cristol
- Laboratoire de Biochimie, Hôpital Lapeyronie, CHU de Montpellier, 34295 Montpellier, France;
| | - Séverine Brabant
- Laboratoire des Explorations Fonctionnelles, Hôpital Necker Enfants Malades, APHP, 75015 Paris, France;
| | | | | | - Eric Renard
- Department of Endocrinology and Diabetes, Lapeyronie Hospital, CHU de Montpellier, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France; (P.L.); (E.R.)
| | - Marie-Christine Picot
- Unité de Recherche Clinique et Epidémiologie, CHU de Montpellier, Université de Montpellier, 34295 Montpellier, France; (S.A.); (M.-C.P.)
| | - Denis Mariano-Goulart
- Département de Biophysique, Université Montpellier, Service de Médecine Nucléaire, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, CHU de Montpellier, CEDEX 5, 34295 Montpellier, France;
- Physiology and Experimental Medecine of the Heart and Muscles (PhyMedExp), Université de Montpellier, INSERM, CNRS, 34295 Montpellier, France;
| | - David Nocca
- Service de Chirurgie Digestive A, Hôpital Saint Eloi, CHU de Montpellier, 34295 Montpellier, France; (M.P.); (M.D.); (D.N.)
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6
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Vilarrasa N, Guerrero-Pérez F. Bariatric surgery: Effects on bone mineral density and fracture risk. ENDOCRINOL DIAB NUTR 2023:S2530-0180(23)00086-0. [PMID: 37225622 DOI: 10.1016/j.endien.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Núria Vilarrasa
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III), Madrid, Spain.
| | - Fernando Guerrero-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; CIBERDEM (CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III), Madrid, Spain
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Mitchell DM, Singhal V, Animashaun A, Bose A, Carmine B, Stanford FC, Inge TH, Kelsey MM, Lee H, Bouxsein ML, Yu EW, Bredella MA, Misra M. Skeletal Effects of Sleeve Gastrectomy in Adolescents and Young Adults: A 2-Year Longitudinal Study. J Clin Endocrinol Metab 2023; 108:847-857. [PMID: 36314507 PMCID: PMC10211497 DOI: 10.1210/clinem/dgac634] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/07/2022] [Indexed: 11/16/2022]
Abstract
CONTEXT Vertical sleeve gastrectomy (VSG) is an increasingly common tool to achieve weight loss and improve metabolic health in adolescents and young adults with obesity, although it may adversely affect bone health. OBJECTIVE This work aimed to evaluate the effect of VSG on bone health in youth. METHODS An observational 2-year study was conducted at a tertiary care center of 66 patients aged 13 to 24 years with moderate-to-severe obesity meeting criteria for VSG. The patients underwent VSG (n = 30) or nonsurgical (n = 36) management per the decision of patient and clinical team. Main outcome measures included dual-energy x-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of bone mineral density (BMD), geometry, and microarchitecture. RESULTS VSG patients achieved 25.3 ± 2.0% weight loss at 2 years (P < .001) while control subjects gained 4.0 ± 2.0% (P = .026). Total hip BMD declined 8.5 ± 1.0% following VSG compared with 0.1 ± 1.0% gain in controls (P < .001), with similar results at the femoral neck (P < .001). Total volumetric BMD (vBMD) decreased both at the distal radius and tibia following VSG (P < .001) driven primarily by trabecular vBMD loss (P < .001). Two-year changes in cortical vBMD did not differ between groups, though cortical porosity decreased following VSG both at the radius and tibia (P = .048 and P < .001). Cortical thickness increased in controls but not in VSG (P = .022 and P = .002 for between-group comparisons at the radius and tibia, respectively). Following VSG, estimated failure load decreased at the radius and did not demonstrate the physiologic increases at the tibia observed in controls. CONCLUSION VSG leads to progressive changes in bone health over 2 years, and may lead to increased skeletal fragility in adolescents and young adults.
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Affiliation(s)
- Deborah M Mitchell
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Vibha Singhal
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Weight Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Abisayo Animashaun
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Brian Carmine
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts 02118, USA
| | - Fatima C Stanford
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Weight Center, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Thomas H Inge
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, Colorado 80045, USA
| | - Megan M Kelsey
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study. Obes Surg 2023; 33:911-919. [PMID: 36609743 DOI: 10.1007/s11695-022-06448-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years. MATERIALS AND METHODS Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm2). RESULTS We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118-1.256) and in total proximal femur (OR=1.158; 95% CI 1.066-1.258), both after adjusting for follow-up and excess weight loss. CONCLUSION After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.
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Courtalin M, Verkindt H, Oukhouya Daoud N, Ramdane N, Cortet B, Pattou F, Paccou J. An Evaluation of the Implementation of the European Calcified Tissue Society Recommendations on the Prevention and Treatment of Osteoporosis Secondary to Bariatric Surgery. Nutrients 2023; 15:nu15041007. [PMID: 36839365 PMCID: PMC9964124 DOI: 10.3390/nu15041007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The purpose of this study was to evaluate the implementation of the European Calcified Tissue Society (ECTS) 2022 recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery. The ECTS 2022 recommendations were applied in a retrospective cohort of postmenopausal women and men aged 50 years and older who were undergoing or had already undergone bariatric surgery. Osteoporosis medication was indicated if any of the following criteria were met: (i) history of recent (within 2 years) fragility fracture after the age of 40 years, (ii) BMD T score ≤ -2 at any of the sites of measurement, and (iii) FRAX® ≥ 20% for major osteoporotic fractures and/or ≥3% for hip fractures. Of the 170 patients (144 women, mean age 59 (55 to 63) years) included between February 2019 and March 2022, 33 were eligible for osteoporosis medication based on the ECTS 2022 recommendations, i.e., a prevalence of 19.6% [CI95%: 13.9%; 26.5%]. Most patients met the BMD T score ≤ -2 criterion (n = 25/170, 14.7% [CI95%: 9.7%; 20.9%]) and/or the history of recent fragility fracture criterion (n = 12/170, 7.1% [CI95%: 3.7%; 12.0%]). In this study, a fifth of our population was found to be eligible for osteoporosis medication after the application of the ECTS 2022 recommendations.
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Affiliation(s)
- Marion Courtalin
- Department of Rheumatology, University of Lille, 59000 Lille, France
| | - Hélène Verkindt
- Department of Endocrine and Metabolic Surgery, University of Lille, 59000 Lille, France
| | - Naima Oukhouya Daoud
- Department of Endocrine and Metabolic Surgery, University of Lille, 59000 Lille, France
| | - Nassima Ramdane
- METRICS: Evaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, 59000 Lille, France
| | - Bernard Cortet
- Department of Rheumatology, University of Lille, 59000 Lille, France
| | - François Pattou
- Department of Endocrine and Metabolic Surgery, University of Lille, 59000 Lille, France
| | - Julien Paccou
- Department of Rheumatology, University of Lille, 59000 Lille, France
- Correspondence:
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10
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Wu KC, Cao S, Weaver CM, King NJ, Patel S, Kim TY, Black DM, Kingman H, Shafer MM, Rogers SJ, Stewart L, Carter JT, Posselt AM, Schafer AL. Intestinal Calcium Absorption Decreases After Laparoscopic Sleeve Gastrectomy Despite Optimization of Vitamin D Status. J Clin Endocrinol Metab 2023; 108:351-360. [PMID: 36196648 PMCID: PMC10091486 DOI: 10.1210/clinem/dgac579] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/30/2022] [Indexed: 01/20/2023]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (LSG), now the most commonly performed bariatric operation, is a highly effective treatment for obesity. While Roux-en-Y gastric bypass is known to impair intestinal fractional calcium absorption (FCA) and negatively affect bone metabolism, LSG's effects on calcium homeostasis and bone health have not been well characterized. OBJECTIVE We determined the effect of LSG on FCA, while maintaining robust 25-hydroxyvitamin D (25OHD) levels and recommended calcium intake. DESIGN, SETTING, PARTICIPANTS Prospective pre-post observational cohort study of 35 women and men with severe obesity undergoing LSG. MAIN OUTCOMES FCA was measured preoperatively and 6 months postoperatively with a gold-standard dual stable isotope method. Other measures included calciotropic hormones, bone turnover markers, and bone mineral density (BMD) by dual-energy X-ray absorptiometry and quantitative computed tomography. RESULTS Mean ± SD FCA decreased from 31.4 ± 15.4% preoperatively to 16.1 ± 12.3% postoperatively (P < 0.01), while median (interquartile range) 25OHD levels were 39 (32-46) ng/mL and 36 (30-46) ng/mL, respectively. Concurrently, median 1,25-dihydroxyvitamin D level increased from 60 (50-82) pg/mL to 86 (72-107) pg/mL (P < 0.01), without significant changes in parathyroid hormone or 24-hour urinary calcium levels. Bone turnover marker levels increased substantially, and areal BMD decreased at the proximal femur. Those with lower postoperative FCA had greater areal BMD loss at the total hip (ρ = 0.45, P < 0.01). CONCLUSIONS FCA decreases after LSG, with a concurrent rise in bone turnover marker levels and decline in BMD, despite robust 25OHD levels and with recommended calcium intake. Decline in FCA could contribute to negative skeletal effects following LSG.
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Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sisi Cao
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA
| | - Connie M Weaver
- Department of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA 92182, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hillary Kingman
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Martin M Shafer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
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11
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Fauny M, Halin M, Allado E, Quilliot D, Brunaud L, Albuisson E, Chary-Valckenaere I, Loeuille D. CT evaluation of bone fragility 2 years after bariatric surgery: an observational study. J Bone Miner Metab 2023; 41:105-112. [PMID: 36418588 DOI: 10.1007/s00774-022-01386-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/30/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The objectives were to evaluate bone fragility on computed tomography (CT) in patients with obesity before and 2 years after bariatric surgery and to identify risk factors for a decrease in the scanographic bone attenuation coefficient of the first lumbar vertebra (SBAC-L1). MATERIALS AND METHODS Patients with obesity who underwent bariatric surgery and CT before and 2 years (± 6 months) after bariatric surgery were included. SBAC-L1 was measured on CT with a fracture threshold at 145 HU. RESULTS 78 patients were included, 85.9% women, mean age of 48.5 years (± 11.4); the mean BMI was 46.2 kg/m2 (± 7) before surgery and 29.8 kg/m2 (± 6.7) 2 years after surgery. There was a significant change in SBAC-L1 2 years after surgery (p = 0.037). In multivariate analysis, the risk factors for having an SBAC-L1 ≤ 145HU 2 years after bariatric surgery in those with an SBAC-L1 > 145HU before surgery were age and sex, with men and older patients having a higher risk (OR 32.6, CI 95% [1.86-568.77], and OR 0.85, CI 95% [0.74-0.98], respectively). CONCLUSION SBAC-L1 was significantly lower two years after bariatric surgery. Men sex and older patients were the risk factors for having an SBAC-L1 below the fracture threshold 2 years after surgery.
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Affiliation(s)
- Marine Fauny
- Department of Rheumatology, University Hospital Nancy, 5 Rue du Morvan, Vandoeuvre‑Lès‑Nancy, 54500, Nancy, France.
- Department of Rheumatology, Saint Charles Hospital, Toul, France.
| | - Marion Halin
- Department of Rheumatology, University Hospital Nancy, 5 Rue du Morvan, Vandoeuvre‑Lès‑Nancy, 54500, Nancy, France
| | - Edem Allado
- University Center of Sports Medicine and Adapted Physical Activity, CHRU-Nancy, 54000, Nancy, France
- Université de Lorraine, DevAH, 54000, Nancy, France
| | - Didier Quilliot
- Department of Endocrinology Diabetology and Nutrition, University Hospital, Nancy, France
- Unité Multidisciplinaire de la Chirurgie de l'obésité (UMCO), University Hospital, Nancy, France
- Inserm UMRS 1256 N-GERE (Nutrition-Genetics-Environmental Risks), Faculty of Medicine, University de Lorraine, Nancy, France
| | - Laurent Brunaud
- Unité Multidisciplinaire de la Chirurgie de l'obésité (UMCO), University Hospital, Nancy, France
- Inserm UMRS 1256 N-GERE (Nutrition-Genetics-Environmental Risks), Faculty of Medicine, University de Lorraine, Nancy, France
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital, Nancy, France
| | - Eliane Albuisson
- Département du Grand Est de Recherche en Soins Primaires: DEGERESP, Faculté de Médecine, Université de Lorraine, 54000, Nancy, France
- Université de Lorraine, CNRS, IECL, 54000, Nancy, France
- Département MPI, Unité de Méthodologie, Data Management et Statistiques UMDS, CHRU-Nancy, DRCI, 54000, Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, University Hospital Nancy, 5 Rue du Morvan, Vandoeuvre‑Lès‑Nancy, 54500, Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, University Hospital Nancy, 5 Rue du Morvan, Vandoeuvre‑Lès‑Nancy, 54500, Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA) UMR 7365 CNRS, University of Lorraine, Nancy, France
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12
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Maxwell CV, Shirley R, O'Higgins AC, Rosser ML, O'Brien P, Hod M, O'Reilly SL, Medina VP, Smith GN, Hanson MA, Adam S, Ma RC, Kapur A, McIntyre HD, Jacobsson B, Poon LC, Bergman L, Regan L, Algurjia E, McAuliffe FM. Management of obesity across women's life course: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:35-49. [PMID: 36635081 PMCID: PMC10107516 DOI: 10.1002/ijgo.14549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
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Affiliation(s)
- Cynthia V Maxwell
- Maternal Fetal Medicine; Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rachelle Shirley
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy C O'Higgins
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian, New York, New York, USA
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of HealthUniversidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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13
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Zou Q, Wei C, Shao Z, Wang H, Xiao Z, Cao L, Mei Z, Zhao W, Jiang Z, Chen Z. Risk of fracture following gastric surgery for benign and malignant conditions: A study level pooled analysis of population-based cohort studies. Front Oncol 2022; 12:1001662. [PMID: 36479064 PMCID: PMC9721391 DOI: 10.3389/fonc.2022.1001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/01/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Metabolic changes may occur following gastric surgery, which has been reported to contribute to bone loss, osteoporosis and even bone fracture. However, the evidence regarding the relationship between gastric surgery for benign and malignant conditions and risk of fracture is controversial. This study was conducted with the aim to evaluate whether gastric surgery is associated with a high risk of fracture. METHODS Major electronic databases were searched from inception through October 2021 for population-based cohort studies investigating the associations between gastric surgery (including bariatric gastric surgeries and surgeries for gastric benign and malignant gastric tumors) and risk of fracture compared with controls. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were derived using the random-effects Mantel-Haenszel model. Multiple subgroup analyses and sensitivity analyses were carried out to test sources of heterogeneity stratified by various study characteristics and the robustness of the results. RESULTS A total of 14 studies comprising 693134 individuals were identified for analysis. The RR for the risk of fracture in people undergoing gastric surgery was 1.45 [95% confidence interval (CI) 1.23 - 1.72; I2 = 95.8%; P < 0.001] compared with that in control populations, among which the fracture sites of upper limb, spine, lower limb, pelvis and hip showed consistent significant results (all P < 0.05), whereas nonsignificant associations was noted for other fracture sites. Significant associations were also observed for patients having total or subtotal gastrectomy (RR 2.22, 95% CI 1.66 to 3.00), gastric bypass (RR 1.48, 95% CI 1.26 to 1.74), and a similar trend was observed for preserved passage procedures (including sleeve gastrectomy, gastric banding, vertical banded gastroplasty and other procedures that preserved the passage through the duodenum and proximal small bowel, in contrast to gastric bypass), though the difference did not reach statistically significant (RR 1.10, 95% CI 0.95 to 1.26). An evident increased risk in the age range from 40-59 years was observed (40-49 years: RR 1.36, 95% CI 1.19-1.55; 50-59 years: RR 2.48, 95% CI 1.58-3.90). CONCLUSION From this large pooled analysis of population-based cohort studies, evidence supports that fracture risk is increased in gastric surgery survivors compared with the control population. Early prevention and effective intervention strategies of bone fracture should be taken from clinicians and health policy makers. CLINICAL TRIAL REGISTRATION PROSPERO (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291394), identifier CRD42021291394.
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Affiliation(s)
- Qiuping Zou
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Emergency Department, Dongguan People’s Hospital, Dongguan, China
| | - Chao Wei
- Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
- Department of Spine Surgery, National Regional Medical Center, Binhai Campus of The Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zhuo Shao
- Department of General Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hao Wang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhihong Xiao
- Department of Spine Surgery, The Second Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Lixing Cao
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zubing Mei
- Department of Anorectal Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Anorectal Disease Institute of Shuguang Hospital, Shanghai, China
| | - Wei Zhao
- Department of General Surgery, Putuo District Central Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi Jiang
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhiqiang Chen
- Department of Perioperative Research Center of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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14
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Holanda N, Crispim N, Carlos I, Moura T, Nóbrega E, Bandeira F. Musculoskeletal effects of obesity and bariatric surgery – a narrative review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:621-632. [PMID: 36382751 PMCID: PMC10118826 DOI: 10.20945/2359-3997000000551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Obesity affects several areas of the human body, leading to increased morbidity and mortality and the likelihood of other diseases, such as type 2 diabetes mellitus, cardiovascular diseases and musculoskeletal disorders. These conditions predispose to bone fractures and sarcopenic obesity, defined by the presence of an obesity-associated decrease in muscle mass and strength. Both bone fragility and sarcopenic obesity disease are consequences of several factors, such as a low degree of chronic inflammation, insulin resistance, hormonal changes, nutritional deficiencies, ectopic fat deposits and sedentary lifestyle. The diagnosis of obesity-related musculoskeletal disorders is limited by the lack of sarcopenia criteria and lower accuracy of bone mineral density measurement by dual-energy X-ray absorptiometry in overweight people. Reducing body weight provides undeniable benefits to this population, however treating cases of severe obesity with bariatric surgery can cause even greater damage to bone and muscle health, especially in the long term. The mechanisms involved in this process are not yet fully understood, but factors related to nutrient malabsorption and mechanical discharge as well as changes in gut hormones, adipokines and bone marrow adiposity should be taken into account. Depending on the surgical technique performed, greater musculoskeletal damage may occur, especially in cases of malabsorptive surgeries such as Roux-en-Y gastric bypass, when compared to restrictive techniques such as sleeve gastrectomy. This difference is probably due to greater weight loss, nutrient malabsorption and important hormonal changes that occur as a consequence of the diversion of intestinal transit and loss of greater absorptive surface. Thus, people undergoing bariatric procedures, especially malabsorptive ones, should have their musculoskeletal health supervised to allow early diagnosis and appropriate therapeutic interventions to prevent osteoporotic fractures and preserve the functionality of the skeletal muscles.
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15
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Paccou J, Genser L, Lespessailles É, Bertin É, Javier RM, Duclos M, Joly AS, Boirie Y, Pattou F, Delarue J, Cortet B. French recommendations on the prevention and treatment of osteoporosis secondary to bariatric surgery. Joint Bone Spine 2022; 89:105443. [PMID: 35908644 DOI: 10.1016/j.jbspin.2022.105443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/27/2022] [Accepted: 07/12/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION This article presents the initial recommendations of the Groupe de Recherche et d'Information sur les Ostéoporoses (Osteoporosis Research and Information Group [GRIO]) and the Société Française de Rhumatologie (French Rheumatology Society [SFR]) on the prevention and treatment of osteoporosis secondary to bariatric surgery. METHODS The recommendations were produced by a working group comprising 4 expert rheumatologists, 3 medically qualified nutritionists, 2 obesity surgeons, 1 physical activity specialist, and 1 patient-association representative. RESULTS The following generally recommended measures apply to all patients with an indication for bariatric surgery or who have already undergone bariatric surgery: normalize calcium and protein intake, attain a 25(OH) vitamin D concentration of between 30 and 60ng/mL; prevent the risk of falls, and introduce a suitable regimen of physical activity. An initial assessment of fracture risk should be routinely performed - ideally before the first bariatric surgery procedure - (i) in the case of RYGB and biliopancreatic diversion, regardless of age, (ii) in patients at high risk of fracture, regardless of age, and (iii) in all menopausal women and all men ≥ 50 years old, regardless of the type of bariatric surgical procedure. The fracture risk assessment is based on a determination of osteoporosis risk factors and bone mineral density measurements. Anti-osteoporosis treatment - zoledronic acid as the first line of treatment - is indicated for menopausal women and men ≥ 50 years old with (i) a history of severe fracture, regardless of T-score, (ii) a history of non-severe fracture and a T-score ≤ -1, and (iii) no history of fracture and a T-score ≤ -2. CONCLUSIONS There is an increased risk of fracture after bariatric surgery. Clinicians should focus their attention on patients at high fracture risk such as postmenopausal women and men older than 50 years. More research is necessary to direct and support guidelines.
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Affiliation(s)
- Julien Paccou
- University Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000 Lille, France.
| | - Laurent Genser
- Sorbonne Université, Department of Digestive and Hepato-Pancreato-Biliary Surgery, Liver Transplantation, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Institut Hospitalo-Universitaire ICAN, Paris, France
| | - Éric Lespessailles
- Department of Rheumatology, Translational Medicine Research Platform, PRIMMO, Regional Hospital of Orleans, 45067 Orléans, France
| | - Éric Bertin
- Clinical Nutrition Transversal Unit (UTNC) of Reims University Hospital and Performance, Health, Metrology, Society Laboratory (PSMS, EA 7507) of Reims Champagne-Ardenne University, Reims, France
| | - Rose-Marie Javier
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | - Martine Duclos
- Department of Sport Medicine and Functional Explorations, University Hospital of Clermont-Ferrand, University Clermont Auvergne, INRAE, Human Nutrition Unit, CRNH Auvergne, Clermont-Ferrand, France
| | - Anne-Sophie Joly
- Collectif National des Associations d'Obeses (CNAO), 92800 Puteaux, France
| | - Yves Boirie
- Clinical Nutrition Department, University Hospital of Clermont-Ferrand, University Clermont Auvergne, INRAE, Human Nutrition Unit, CRNH Auvergne, Clermont-Ferrand, France
| | - François Pattou
- Department of Metabolic and Endocrine Surgery, CHRU Lille, Lille, France
| | - Jacques Delarue
- Department of Nutritional Sciences and Laboratory of Human Nutrition, University Hospital, Faculty of Medicine, University of Brest, Brest, France
| | - Bernard Cortet
- University Lille, CHU Lille, MABlab ULR 4490, Department of Rheumatology, 59000 Lille, France
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16
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Corsi GC, Pinheiro MCDA, Caldas APS, Dias MCG, Santo MA, Pajecki D. BONE HEALTH ASSESSMENT OF ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:513-521. [PMID: 36515347 DOI: 10.1590/s0004-2803.202204000-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.
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Affiliation(s)
- Giovanna Cavanha Corsi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Moisés Carmo Dos Anjos Pinheiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Ana Paula Silva Caldas
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
| | - Denis Pajecki
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
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17
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Hernández-Martínez A, Veras L, Boppre G, Soriano-Maldonado A, Oliveira J, Diniz-Sousa F, Fonseca H. Changes in volumetric bone mineral density and bone quality after Roux-en-Y gastric bypass: A meta-analysis with meta-regression. Obes Rev 2022; 23:e13479. [PMID: 35665991 PMCID: PMC9541815 DOI: 10.1111/obr.13479] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
This meta-analysis aimed to assess the effect of Roux-en-Y gastric bypass (RYGB) on three-dimensionally assessed volumetric bone mineral density (vBMD) with the effect of time on these changes, on bone quality, and the agreement of dual-energy X-ray absorptiometry (DXA) with quantitative computed tomography (QCT) or high-resolution peripheral QCT (HR-pQCT) estimates of bone loss. We searched PubMed, Web of Science, Cochrane, Scopus, and EBSCO. Longitudinal studies on adults undergoing RYGB in which vBMD was assessed by QCT or HR-pQCT with ≥6 months follow-up were included. Total hip (TH) changes were reported in four studies, lumbar spine (LS) in eight, radius in eight, and tibia in seven. Significant post-RYGB vBMD reductions occurred at all skeletal sites analyzed. Meta-regression revealed that time post-RYGB was significantly associated with vBMD deterioration in all skeletal sites except at the TH. RYGB also led to significant deterioration on bone quality. DXA underestimated LS and overestimated TH bone losses post-RYGB. In conclusion, RYGB was associated with significant vBMD loss, which makes screening of bone mass progression by three-dimensional technology a crucial clinical issue to prevent fracture risk and osteoporosis.
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Affiliation(s)
- Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Lucas Veras
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal.,Human Motricity Research Center, University Adventista, Chillan, Chile
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Florêncio Diniz-Sousa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sports, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
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18
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Paccou J, Caiazzo R, Lespessailles E, Cortet B. Bariatric Surgery and Osteoporosis. Calcif Tissue Int 2022; 110:576-591. [PMID: 33403429 DOI: 10.1007/s00223-020-00798-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
It has been increasingly acknowledged that bariatric surgery adversely affects skeletal health. After bariatric surgery, the extent of high-turnover bone loss is much greater than what would be expected in the absence of a severe skeletal insult. Patients also experience a significant deterioration in bone microarchitecture and strength. There is now a growing body of evidence that suggests an association between bariatric surgery and higher fracture risk. Although the mechanisms underlying the high-turnover bone loss and increase in fracture risk after bariatric surgery are not fully understood, many factors seem to be involved. The usual suspects are nutritional factors and mechanical unloading, and the roles of gut hormones, adipokines, and bone marrow adiposity should be investigated further. Roux-en-Y gastric bypass (RYGB) was once the most commonly performed bariatric procedure worldwide, but sleeve gastrectomy (SG) has now become the predominant bariatric procedure. Accumulating evidence suggests that RYGB is associated with a greater reduction in BMD, a greater increase in markers of bone turnover, and a higher risk of fracture than SG. These findings should be taken into consideration in determining the most appropriate bariatric procedure for patients, especially those at higher fracture risk. Before and after all bariatric procedures, sufficient calcium, vitamin D and protein intake, and adequate physical activity, are needed to counteract negative impacts on bone. There are no studies to date that have evaluated the effect of osteoporosis treatment on high-turnover bone loss after bariatric surgery. However, in patients with a diagnosis of osteoporosis, anti-resorptive agents may be considered.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France.
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, 2, Avenue Oscar Lambret, 59037, Lille, France.
| | - Robert Caiazzo
- Inserm, Endocrine and Metabolic Surgery, UMR 1190, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Eric Lespessailles
- Department of Rheumatology, CHR Orléans, I3MTO EA 4708, Univ. Orléans, 45067, Orléans, France
| | - Bernard Cortet
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
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19
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Zhao M, Mei F, Lu J, Xiang Q, Xia G, Zhang X, Liu Z, Zhang C, Shen X, Zhong Q. Gadus morhua Eggs Sialoglycoprotein Prevent Estrogen Deficiency-Induced High Bone Turnover by Controlling OPG/RANKL/TRAF6 Pathway and Serum Metabolism. Front Nutr 2022; 9:871521. [PMID: 35495954 PMCID: PMC9040668 DOI: 10.3389/fnut.2022.871521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/01/2022] [Indexed: 12/26/2022] Open
Abstract
In recent years, the development of safe and effective anti-osteoporosis factors has attracted extensive attention. In this study, an estrogen-deficient osteoporosis rat model was employed to study the improving mechanism of sialoglycoprotein isolated from Gadus morhua eggs (Gds) against osteoporosis. The results showed that compared with OVX, Gds ameliorated the trabecular microstructure, especially the increased trabecular thickness, decreased trabecular separation, and enhanced the trabecular number. The analysis of qRT-PCR and western blotting found that Gds reduced bone resorption by inhibiting RANKL-induced osteoclastogenesis. The LC-MS/MS was used to investigate serum metabolism, and the enrichment metabolites were analyzed by the KEGG pathway. The results revealed that the Gds significantly altered the fat anabolism pathway, which includes ovarian steroidogenesis pathway and arachidonic acid metabolism pathway. Altogether, Gds could improve osteoporosis by suppressing high bone turnover via controlling OPG/RANKL/TRAF6 pathway, which is implicated with ovarian steroidogenesis pathway and arachidonic acid metabolism pathway. These findings indicated that Gds could be a candidate factor for anti-osteoporosis.
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Affiliation(s)
- Meihui Zhao
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Fengfeng Mei
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Jinfeng Lu
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
| | - Qingying Xiang
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
| | - Guanghua Xia
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
- *Correspondence: Guanghua Xia,
| | - Xueying Zhang
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Zhongyuan Liu
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Chenghui Zhang
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Xuanri Shen
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Collaborative Innovation Center of Provincial and Ministerial Co-construction for Marine Food Deep Processing, Dalian Polytechnic University, Dalian, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
| | - Qiuping Zhong
- Hainan Engineering Research Center of Aquatic Resources Efficient Utilization in South China Sea, School of Food Science and Engineering, Hainan University, Hainan, China
- Key Laboratory of Food Nutrition and Functional Food of Hainan Province, Hainan University, Haikou, China
- Qiuping Zhong,
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20
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Sadoughi S, Pasco C, Joseph GB, Wu PH, Schafer AL, Kazakia GJ. Cortical Bone Loss Following Gastric Bypass Surgery Is Not Primarily Endocortical. J Bone Miner Res 2022; 37:753-763. [PMID: 35067981 PMCID: PMC9071182 DOI: 10.1002/jbmr.4512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 12/28/2021] [Accepted: 01/11/2022] [Indexed: 11/09/2022]
Abstract
Roux-en Y gastric bypass (RYGB) surgery is an effective treatment for obesity; however, it may negatively impact skeletal health by increasing fracture risk. This increase may be the result not only of decreased bone mineral density but also of changes in bone microstructure, for example, increased cortical porosity. Increased tibial and radial cortical porosity of patients undergoing RYGB surgery has been observed as early as 6 months postoperatively; however, local microstructural changes and associated biological mechanisms driving this increase remain unclear. To provide insight, we studied the spatial distribution of cortical porosity in 42 women and men (aged 46 ± 12 years) after RYGB surgery. Distal tibias and radii were evaluated with high-resolution peripheral quantitative computed tomography (HR-pQCT) preoperatively and at 12 months postoperatively. Laminar analysis was used to determine cortical pore number and size within the endosteal, midcortical, and periosteal layers of the cortex. Paired t tests were used to compare baseline versus follow-up porosity parameters in each layer. Mixed models were used to compare longitudinal changes in laminar analysis outcomes between layers. We found that the midcortical (0.927 ± 0.607 mm-2 to 1.069 ± 0.654 mm-2 , p = 0.004; 0.439 ± 0.293 mm-2 to 0.509 ± 0.343 mm-2 , p = 0.03) and periosteal (0.642 ± 0.412 mm-2 to 0.843 ± 0.452 mm-2 , p < 0.0001; 0.171 ± 0.101 mm-2 to 0.230 ± 0.160 mm-2 , p = 0.003) layers underwent the greatest increases in porosity over the 12-month period at the distal tibia and radius, respectively. The endosteal layer, which had the greatest porosity at baseline, did not undergo significant porosity increase over the same period (1.234 ± 0.402 mm-2 to 1.259 ± 0.413 mm-2 , p = 0.49; 0.584 ± 0.290 mm-2 to 0.620 ± 0.299 mm-2 , p = 0.35) at the distal tibia and radius, respectively. An alternative baseline-mapping approach for endosteal boundary definition confirmed that cortical bone loss was not primarily endosteal. These findings indicate that increases in cortical porosity happen in regions distant from the endosteal surface, suggesting that the underlying mechanism driving the increase in cortical porosity is not merely endosteal trabecularization. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Saghi Sadoughi
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Courtney Pasco
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Gabby B Joseph
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Po-Hung Wu
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Anne L Schafer
- Department of Medicine, University of California, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco VA Health Care System, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Galateia J Kazakia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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21
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Wu KC, Cao S, Weaver CM, King NJ, Patel S, Kingman H, Sellmeyer DE, McCauley K, Li D, Lynch SV, Kim TY, Black DM, Shafer MM, Özçam M, Lin DL, Rogers SJ, Stewart L, Carter JT, Posselt AM, Schafer AL. Prebiotic to Improve Calcium Absorption in Postmenopausal Women After Gastric Bypass: A Randomized Controlled Trial. J Clin Endocrinol Metab 2022; 107:1053-1064. [PMID: 34888663 PMCID: PMC8947782 DOI: 10.1210/clinem/dgab883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The adverse skeletal effects of Roux-en-Y gastric bypass (RYGB) are partly caused by intestinal calcium absorption decline. Prebiotics, such as soluble corn fiber (SCF), augment colonic calcium absorption in healthy individuals. OBJECTIVE We tested the effects of SCF on fractional calcium absorption (FCA), biochemical parameters, and the fecal microbiome in a post-RYGB population. METHODS Randomized, double-blind, placebo-controlled trial of 20 postmenopausal women with history of RYGB a mean 5 years prior; a 2-month course of 20 g/day SCF or maltodextrin placebo was taken orally. The main outcome measure was between-group difference in absolute change in FCA (primary outcome) and was measured with a gold standard dual stable isotope method. Other measures included tolerability, adherence, serum calciotropic hormones and bone turnover markers, and fecal microbial composition via 16S rRNA gene sequencing. RESULTS Mean FCA ± SD at baseline was low at 5.5 ± 5.1%. Comparing SCF to placebo, there was no between-group difference in mean (95% CI) change in FCA (+3.4 [-6.7, +13.6]%), nor in calciotropic hormones or bone turnover markers. The SCF group had a wider variation in FCA change than placebo (SD 13.4% vs 7.0%). Those with greater change in microbial composition following SCF treatment had greater increase in FCA (r2 = 0.72, P = 0.05). SCF adherence was high, and gastrointestinal symptoms were similar between groups. CONCLUSION No between-group differences were observed in changes in FCA or calciotropic hormones, but wide CIs suggest a variable impact of SCF that may be due to the degree of gut microbiome alteration. Daily SCF consumption was well tolerated. Larger and longer-term studies are warranted.
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Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Correspondence: Karin C. Wu, MD, 1700 Owens St. RM 349, San Francisco, CA 94158, USA.
| | - Sisi Cao
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Hillary Kingman
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Deborah E Sellmeyer
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Kathryn McCauley
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Danny Li
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Susan V Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Martin M Shafer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Mustafa Özçam
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Din L Lin
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
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22
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Auge M, Menahem B, Savey V, Lee Bion A, Alves A. Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why? J Visc Surg 2022; 159:298-308. [PMID: 35304081 DOI: 10.1016/j.jviscsurg.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.
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Affiliation(s)
- M Auge
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France.
| | - V Savey
- Service de nutrition, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Lee Bion
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France
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23
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Mendonça F, Soares R, Carvalho D, Freitas P. The Impact of Bariatric Surgery on Bone Health: State of the Art and New Recognized Links. Horm Metab Res 2022; 54:131-144. [PMID: 35276738 DOI: 10.1055/a-1767-5581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bariatric surgery (BS) is the most effective therapy for severe obesity, which improves several comorbidities (such as diabetes, hypertension, dyslipidemia, among others) and results in marked weight loss. Despite these consensual beneficial effects, sleeve gastrectomy and Roux-en-Y gastric bypass (the two main bariatric techniques) have also been associated with changes in bone metabolism and progressive bone loss. The objective of this literature review is to examine the impact of bariatric surgery on bone and its main metabolic links, and to analyze the latest findings regarding the risk of fracture among patients submitted to bariatric surgery.
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Affiliation(s)
- Fernando Mendonça
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Raquel Soares
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
- Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Paula Freitas
- Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar e Universitário de S. João, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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24
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Saad RK, Ghezzawi M, Habli D, Alami RS, Chakhtoura M. Fracture risk following bariatric surgery: a systematic review and meta-analysis. Osteoporos Int 2022; 33:511-526. [PMID: 34988627 DOI: 10.1007/s00198-021-06206-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery may negatively impact bone health. We aimed to compare fracture risk following bariatric surgery by type (malabsorptive, restrictive), or to non-surgical weight loss, or to controls with obesity. We systematically searched four databases from inception until October 2020. We included observational and interventional studies on adults. We screened articles and abstracted data in duplicate and independently and assessed the risk of bias. We conducted random-effects model meta-analyses (Review Manager v5.3), to calculate the relative risk of any or site-specific fracture (CRD42019128536). We identified four trials of unclear-to-high risk of bias and 15 observational studies of fair-to-good quality. Data on fracture risk following bariatric surgery compared to medical weight loss is scarce and limited by the small number of participants. In observational studies, at a mean/median post-operative follow-up > 2 years, the relative risk of any fracture was 45% (p < 0.001) and 61% (p = 0.04) higher following malabsorptive procedures compared to obese controls and restrictive procedures, respectively, with moderate to high heterogeneity. Site-specific relative fracture risk (hip and wrist) was one- to two-folds higher post malabsorptive procedures compared to obese controls or restrictive procedures. The risks of any and of site-specific fracture were not increased following restrictive procedures compared to obese controls. Fracture risk seems to increase following malabsorptive bariatric surgeries, at a mean/median follow-up > 2 years. The risk is not increased with restrictive surgeries. The available evidence has several limitations. A prospective and rigorous long-term follow-up of patients following bariatric surgery is needed for a better assessment of their fracture risk with aging.
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Affiliation(s)
- R K Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Ghezzawi
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - D Habli
- Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, Lebanon
| | - R S Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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25
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Salman MA, Aradaib M, Salman A, Elewa A, Tourky M, Shaaban HED. Effects of Gastric Bypass and Sleeve Gastrectomy on Bone Mineral Density and Bone Turnover Markers: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:865-875. [PMID: 35006326 DOI: 10.1007/s00268-021-06429-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is a growing interest in the post-operative bone-related effects of bariatric surgery. However, little is known about the comparative effects of the most commonly performed bariatric procedures, namely Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). OBJECTIVES To systematically assess the differences in areal bone mineral density (aBMD) and biochemical and hormonal markers of bone metabolism among patients undergoing RYGB and SG. METHODS We conducted a systematic review and meta-analysis of studies aBMD at different sites, as well as bone-specific alkaline phosphatase (BALP), 25-OH-vitamin D, calcium and parathyroid hormone (PTH) after RYGB and SG. RESULTS Fourteen studies were included (717 patients, 50.63% in the RYGB arm). Based on data collected at 1 year, 2 years and > 2 years, there were no significant differences in aBMD measurements at the total hip, lumbar spine, femoral neck, and the whole body with no statistical heterogeneity among different comparisons. Patients in the RYGB group showed significantly higher concentrations of BALP at 1 year (SMD = 0.52, 95%CI, 0.23-0.81, p = 0.0004) and PTH at > 2 years of follow-up (SMD = 0.68, 95%CI, 0.31-1.05, p = 0.0003) compared to the SG group. CONCLUSION There were no significant differences in aBMD measurements at the hip, lumbar spine, femoral neck, and the total body following RYGB and SG procedures. However, BALP and PTH concentrations were significantly higher after RYGB surgeries compared to SG. Attention should be paid to patients undergoing RYGB to prevent the expected skeletal fragility over time.
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Affiliation(s)
- Mohamed AbdAlla Salman
- General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
| | - Mohammed Aradaib
- General Surgery Department, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Ahmed Salman
- Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Elewa
- General Surgery Department Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Mohamed Tourky
- General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK
| | - Hossam El-Din Shaaban
- Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
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Mirhosseini Dehabadi S, Sayadi Shahraki M, Mahmoudieh M, Kalidari B, Melali H, Mousavi M, Ghourban Abadi M, Mirhosseini S. Bone health after bariatric surgery: Consequences, prevention, and treatment. Adv Biomed Res 2022; 11:92. [DOI: 10.4103/abr.abr_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
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Fonseca HRM, Diniz-Sousa JF. Possible long-term negative bone health consequences of pediatric bariatric surgery: First do no harm. Obesity (Silver Spring) 2022; 30:9-10. [PMID: 34738301 DOI: 10.1002/oby.23302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Hélder Rui Martins Fonseca
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport Sciences and Physical Education, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - José Florêncio Diniz-Sousa
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport Sciences and Physical Education, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
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Mele C, Caputo M, Ferrero A, Daffara T, Cavigiolo B, Spadaccini D, Nardone A, Prodam F, Aimaretti G, Marzullo P. Bone Response to Weight Loss Following Bariatric Surgery. Front Endocrinol (Lausanne) 2022; 13:921353. [PMID: 35873004 PMCID: PMC9301317 DOI: 10.3389/fendo.2022.921353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022] Open
Abstract
Obesity is a global health challenge that warrants effective treatments to avoid its multiple comorbidities. Bariatric surgery, a cornerstone treatment to control bodyweight excess and relieve the health-related burdens of obesity, can promote accelerated bone loss and affect skeletal strength, particularly after malabsorptive and mixed surgical procedures, and probably after restrictive surgeries. The increase in bone resorption markers occurs early and persist for up to 12 months or longer after bariatric surgery, while bone formation markers increase but to a lesser extent, suggesting a potential uncoupling process between resorption and formation. The skeletal response to bariatric surgery, as investigated by dual-energy X-ray absorptiometry (DXA), has shown significant loss in bone mineral density (BMD) at the hip with less consistent results for the lumbar spine. Supporting DXA studies, analyses by high-resolution peripheral quantitative computed tomography (HR-pQCT) showed lower cortical density and thickness, higher cortical porosity, and lower trabecular density and number for up to 5 years after bariatric surgery. These alterations translate into an increased risk of fall injury, which contributes to increase the fracture risk in patients who have been subjected to bariatric surgery procedures. As bone deterioration continues for years following bariatric surgery, the fracture risk does not seem to be dependent on acute weight loss but, rather, is a chronic condition with an increasing impact over time. Among the post-bariatric surgery mechanisms that have been claimed to act globally on bone health, there is evidence that micro- and macro-nutrient malabsorptive factors, mechanical unloading and changes in molecules partaking in the crosstalk between adipose tissue, bone and muscle may play a determining role. Given these circumstances, it is conceivable that bone health should be adequately investigated in candidates to bariatric surgery through bone-specific work-up and dedicated postsurgical follow-up. Specific protocols of nutrients supplementation, motor activity, structured rehabilitative programs and, when needed, targeted therapeutic strategies should be deemed as an integral part of post-bariatric surgery clinical support.
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Affiliation(s)
- Chiara Mele
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- *Correspondence: Chiara Mele,
| | - Marina Caputo
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Alice Ferrero
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Tommaso Daffara
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Beatrice Cavigiolo
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Daniele Spadaccini
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Antonio Nardone
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute, Pavia, and Neurorehabilitation of Montescano Institute, Montescano, PV, Italy
| | - Flavia Prodam
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, University Hospital “Maggiore della Carità”, Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Istituto Auxologico Italiano, IRCCS, Laboratory of Metabolic Research, S. Giuseppe Hospital, Piancavallo, Italy
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Paccou J, Tsourdi E, Meier C, Palermo A, Pepe J, Body JJ, Zillikens MC. Bariatric surgery and skeletal health: A narrative review and position statement for management by the European Calcified Tissue Society (ECTS). Bone 2022; 154:116236. [PMID: 34688942 DOI: 10.1016/j.bone.2021.116236] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT Numerous studies have demonstrated detrimental skeletal consequences following bariatric surgery. METHODS A working group of the European Calcified Tissue Society (ECTS) performed an updated review of existing literature on changes of bone turnover markers (BTMs), bone mineral density (BMD), and fracture risk following bariatric surgery and provided advice on management based on expert opinion. LITERATURE REVIEW Based on observational studies, bariatric surgery is associated with a 21-44% higher risk of all fractures. Fracture risk is time-dependent and increases approximately 3 years after bariatric surgery. The bariatric procedures that have a malabsorptive component (including Roux-en-Y Gastric bypass (RYGB) and biliopancreatic diversion (BPD)) have clearly been associated with the highest risk of fracture. The extent of high-turnover bone loss suggests a severe skeletal insult. This is associated with diminished bone strength and compromised microarchitecture. RYGB was the most performed bariatric procedure worldwide until very recently, when sleeve gastrectomy (SG) became more prominent. There is growing evidence that RYGB is associated with greater reduction in BMD, greater increase in BTMs, and higher risk of fractures compared with SG but RCTs on optimal management are still lacking. EXPERT OPINION In all patients, it is mandatory to treat vitamin D deficiency, to achieve adequate daily calcium and protein intake and to promote physical activity before and following bariatric surgery. In post-menopausal women and men older than 50 years, osteoporosis treatment would be reasonable in the presence of any of the following criteria: i) history of recent fragility fracture after 40 years of age, ii) BMD T-score ≤ -2 at hip or spine, iii) FRAX score with femoral neck BMD exceeding 20% for the 10-year major osteoporotic fracture probability or exceeding 3% for hip fracture. Zoledronate as first choice should be preferred due to intolerance of oral formulations and malabsorption. Zoledronate should be used with caution due to hypocemia risk. It is recommended to ensure adequate 25-OH vitamin D level and calcium supplementation before administering zoledronate. CONCLUSIONS The bariatric procedures that have a malabsorptive component have been associated with the highest turnover bone loss and risk of fracture. There is a knowledge gap on osteoporosis treatment in patients undergoing bariatric surgery. More research is necessary to direct and support guidelines.
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Affiliation(s)
- Julien Paccou
- Univ. Lille, CHU Lille, MABLab ULR 4490, Department of Rheumatology, 59000 Lille, France.
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Christian Meier
- Division of Endocrinology, Diabetes and Metabolism, University Hospital and University of Basel, Switzerland
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, "Sapienza" University of Rome, Italy
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Carola Zillikens
- Bone Center Erasmus MC, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Paccou J, Thuillier D, Courtalin M, Pigny P, Labreuche J, Cortet B, Pattou F. A comparison of changes in bone turnover markers after gastric bypass and sleeve gastrectomy, and their association with markers of interest. Surg Obes Relat Dis 2021; 18:373-383. [PMID: 34973928 DOI: 10.1016/j.soard.2021.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND It is still debated whether differences in bone turnover markers (BTMs) exist between the 2 most popular bariatric surgery procedures (Roux-en-Y gastric bypass [RYGB] and sleeve gastrectomy [SG]). OBJECTIVES To compare changes in BTMs after RYGB and SG, and to investigate their association with predefined markers of interest. SETTING University hospital, Lille, France. METHODS An ancillary investigation of a prospective cohort was conducted. SG patients with severe obesity ≥40 years were matched one-to-one to RYGB patients for age, sex, body mass index (BMI), and menopausal status. BTMs, as well as predefined markers of interest, were measured at baseline, 12, and 24 months after bariatric surgery. RESULTS Sixty-four patients (66% women) had a mean (standard deviation [SD]) age of 49.6 years (5.1) and a mean (SD) BMI of 45.0 kg/m2 (6.0). From baseline to 12 months, a significant increase in BTMs was observed in both groups (P < .001). Moreover, RYGB was associated with a greater increase in C-terminal telopeptide (β-CTX) and procollagen type 1 N-terminal propeptide (PINP) compared with SG (P < .0001). From 12 to 24 months, a significant decrease in BTMs was observed in both groups, but no significant differences were found between RYGB and SG. However, BTMs did not return to baseline levels. The changes in PINP and β-CTX at 12 months were independently associated with the type of surgical procedure, after adjusting for weight or each predefined marker of interest (all P < .0001). CONCLUSION RYGB was associated with a greater increase in BTMs than SG at 12 and 24 months.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, University of Lille, Lille, France.
| | - Dorothée Thuillier
- Department of Endocrine and Metabolic Surgery, University of Lille, Lille, France
| | | | - Pascal Pigny
- Department of Cancer Heterogeneity, Plasticity and Resistance to Therapies (CANTHER), University of Lille, Lille, France
| | - Julien Labreuche
- METRICS: Évaluation des technologies de santé et des pratiques médicales, University of Lille, Lille, France
| | - Bernard Cortet
- Department of Rheumatology, University of Lille, Lille, France
| | - François Pattou
- Department of Endocrine and Metabolic Surgery, University of Lille, Lille, France
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Hadi YB, Mann R, Sohail AH, Shah-Khan SM, Szoka N, Abunnaja S, Tabone LE, Thakkar S, Singh S. Metabolic bone disease and fracture risk after gastric bypass and sleeve gastrectomy: comparative analysis of a multi-institutional research network. Surg Obes Relat Dis 2021; 18:604-609. [DOI: 10.1016/j.soard.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/08/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
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Beavers KM, Beavers DP, Fernandez AZ, Greene KA, Swafford AA, Weaver AA, Wherry SJ, Ard JD. Risedronate use to attenuate bone loss following sleeve gastrectomy: Results from a pilot randomized controlled trial. Clin Obes 2021; 11:e12487. [PMID: 34569167 PMCID: PMC8563448 DOI: 10.1111/cob.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to explore the efficacy of 150 mg once monthly oral risedronate use in the prevention of sleeve gastrectomy (SG) associated bone loss. Twenty-four SG patients (56 ± 7 years, 83% female, 21% black) were randomized to risedronate or placebo for 6 months, with an optional 12-month assessment. Outcome measures included 6 (n = 21) and 12 (n = 14) month change in dual energy x-ray absorptiometry-acquired regional areal bone mineral density (aBMD). Six-month treatment effect estimates [mean (95% CI)] revealed significant between group aBMD differences at the femoral neck [risedronate: +0.013 g/cm2 (-0.021, 0.046) vs. placebo: -0.041 g/cm2 (-0.067, -0.015)] and lumbar spine [risedronate: +0.028 g/cm2 (-0.006, 0.063) vs. placebo: -0.029 g/cm2 (-0.054, -0.004)]; both p ≤ 0.02. When followed postoperatively to 12 months, differential aBMD treatment effects were observed at the total hip [risedronate: -0.035 g/cm2 (-0.061, -0.009) vs. placebo: -0.072 g/cm2 (-0.091, -0.052)] and lumbar spine [risedronate: +0.012 g/cm2 (-0.038, 0.063) vs. placebo: -0.052 g/cm2 (-0.087, -0.017)]; both p < 0.05. Preliminary treatment effect estimates signal 6 months of risedronate use may be efficacious in reducing aBMD loss at the axial skeleton post-SG, with benefit largely maintained throughout the 1-year postoperative period. Confirmatory data from an adequately powered trial are needed.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ashlyn A. Swafford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah J. Wherry
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jamy D. Ard
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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Chaves Pereira de Holanda N, de Lima Carlos I, Chaves de Holanda Limeira C, Cesarino de Sousa D, Serra de Lima Junior FA, Telis de Vilela Araújo A, Peres Montenegro AC, Bandeira F. Fracture Risk After Bariatric Surgery: A Systematic Literature Review and Meta-Analysis. Endocr Pract 2021; 28:58-69. [PMID: 34563701 DOI: 10.1016/j.eprac.2021.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Bariatric surgery has undeniable benefits for cardiovascular and metabolic health, but it can result in negative effects on mineral and bone metabolism. This study aimed to review the current data on fractures after the main types of bariatric surgery. METHODS Therefore, a systematic review was performed using the electronic literature available in the databases LILACS, CENTRAL, Web of Science, Embase, and PubMed/MEDLINE, with results until January 2021. Keywords were descriptors for bariatric surgery or bariatric medicine or bariatrics or gastroplasty and bone or bones or bone fractures, referenced in all words of the text in the study. RESULTS The meta-analysis of observational studies and interventional trials showed that the risk of any type of fracture was higher in the surgical group than in the nonsurgical group (relative risk [RR], 1.20 [95% confidence interval {CI}, 1.15-1.26; P < .00001; Phetero < 0.000001; I2 = 94%], and RR, 1.16 [95% CI, 1.00-1.33; P = .04; Phetero = 0.27; I2 = 23%], respectively). It is worth noting that the included interventional studies have a low rating on the risk of bias assessment scales. Compared with those who underwent restrictive procedures, subjects had an increased fracture risk after malabsorptive procedures (RR, 0.49 [95% CI, 0.40-0.61; P < .00001); Phetero = 0.96; I2 = 0%). CONCLUSION We found that bariatric procedures are associated with an increased risk of fractures, especially the malabsorptive techniques.
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Affiliation(s)
- Narriane Chaves Pereira de Holanda
- Department of Endocrinology, Federal University of Paraiba, João Pessoa, Brazil; Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil.
| | | | | | | | | | | | | | - Francisco Bandeira
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil; Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil
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The impact of preoperative vitamin administration on skeletal status following sleeve gastrectomy in young and middle-aged women: a randomized controlled trial. Int J Obes (Lond) 2021; 45:1925-1936. [PMID: 33980995 DOI: 10.1038/s41366-021-00845-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/29/2021] [Accepted: 04/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The appropriate strategies to minimize skeletal deterioration following bariatric surgeries are inconclusive. This randomized controlled trial evaluated the effect of preoperative vitamin supplementation on bone mineral density (BMD) and biochemical parameters in females post-sleeve gastrectomy (SG). METHODS Participants were randomized to a 2-month preoperative treatment with a multivitamin and vitamin D 4000 IU/d (intervention arm) or 1200 IU/d (control arm). Preoperative and 12-month postoperative follow-up evaluations included anthropometrics, biochemical parameters, and dual energy X-ray absorptiometry (DEXA). RESULTS Sixty-two females (median age 29.7 years and median BMI 43.4 kg/m2) were recruited, 87% completed the 12-month follow-up. For the intervention and control arms, significant and similar reductions at 12-months post-surgery were observed in BMD of the hip (-6.8 ± 3.7% vs. -6.0 ± 3.6%; P = 0.646) and of the femoral neck (-7.1 ± 5.8% vs. -7.2 ± 5.5%; P = 0.973). For the intervention compared to the control arm, the 25 hydroxyvitamin D (25(OH)D) increment was greater after 2 months treatment, and vitamin D deficiency rates were lower at 3 and 6-months follow-up (P < 0.016). However, at 12-months postoperative, 25(OH)D values and vitamin D deficiency were comparable between the arms (P > 0.339). Predictors for BMD decline in the total hip were the percentage of excess weight-loss, age>50 years, and lower initial BMI (P ≤ 0.003). CONCLUSIONS SG was associated with a significant decline in BMD of the hip and femoral neck in young and middle-aged women, and was unaffected by preoperative vitamin D supplementation. Females who are peri-menopausal or with greater postoperative weight-loss should be particularly followed for BMD decline.
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Nuzzo A, Czernichow S, Hertig A, Ledoux S, Poghosyan T, Quilliot D, Le Gall M, Bado A, Joly F. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol 2021; 6:238-251. [PMID: 33581762 DOI: 10.1016/s2468-1253(20)30331-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
Obesity and the corresponding burden of related diseases is a major public health issue worldwide that is reaching pandemic proportions. Bariatric surgery is the only intervention that has been shown to result in substantial and lasting weight loss, and a decrease in overall mortality for patients with severe obesity. Consequently, the population of patients having undergone this procedure is increasing. Multifactorial weight-dependent and independent mechanisms underlying metabolic diseases could also drive preventable, but potentially life-threatening, long-term nutritional complications. However, given post-bariatric patients are prone to functional gastrointestinal symptoms and substantial weight loss, nutritional complications might be challenging. This Review is focused on the prevention and treatment of nutritional complications after bariatric surgery in the clinical setting.
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Affiliation(s)
- Alexandre Nuzzo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France
| | - Sebastien Czernichow
- Université de Paris, Paris, France; AP-HP, Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Alexandre Hertig
- AP-HP, Department of Nephrology, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Ledoux
- Université de Paris, Paris, France; AP-HP, Service des Explorations Fonctionnelles, Centre Spécialisé Obésité, Hôpital Louis Mourier, Colombes, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Tigran Poghosyan
- Université de Paris, Paris, France; Service de Chirurgie Digestive, Oncologique et Bariatrique, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Didier Quilliot
- Unité Multidisciplinaire de Chirurgie de l'Obésité, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy Cedex, France
| | - Maude Le Gall
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - André Bado
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Francisca Joly
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France.
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Hofsø D, Hillestad TOW, Halvorsen E, Fatima F, Johnson LK, Lindberg M, Svanevik M, Sandbu R, Hjelmesæth J. Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg). J Clin Endocrinol Metab 2021; 106:501-511. [PMID: 33150385 PMCID: PMC7823313 DOI: 10.1210/clinem/dgaa808] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with an increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health. OBJECTIVE To compare changes in bone mineral density and markers of bone turnover 1 year after SG and RYGB. DESIGN, SETTING, PATIENTS, AND INTERVENTIONS Randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB. MAIN OUTCOME MEASURES Changes in areal bone mineral density (aBMD) and bone turnover markers. RESULTS Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n = 44) than after SG (n = 48) (mean [95% confidence interval] between group differences -2.8% [-4.7 to -0.8], -3.0% [-5.0 to -0.9], -4.2% [-6.4 to -2.1], and -0.5% [-1.6 to 0.6], respectively). The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG (between group difference at 1 year, both P < 0.001). The changes in femoral neck, total hip, and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P < 0.05) and not weight change. CONCLUSIONS Roux-en-Y gastric bypass was associated with a greater reduction in aBMD and a greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB.
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Affiliation(s)
- Dag Hofsø
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Correspondence and Reprint Requests: Dag Hofsø, MD, PhD, Morbid Obesity Center, Department of Medicine, Vestfold Hospital Trust, Boks 2168, 3103 Tønsberg, Norway. E-mail:
| | | | - Erling Halvorsen
- Department of Radiology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Farhat Fatima
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Morten Lindberg
- Department of Laboratory Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marius Svanevik
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Rune Sandbu
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Surgery, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jøran Hjelmesæth
- Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Beavers KM, Greene KA, Yu EW. MANAGEMENT OF ENDOCRINE DISEASE: Bone complications of bariatric surgery: updates on sleeve gastrectomy, fractures, and interventions. Eur J Endocrinol 2020; 183:R119-R132. [PMID: 32869608 PMCID: PMC8254876 DOI: 10.1530/eje-20-0548] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Bredella MA, Singhal V, Hazhir Karzar N, Animashaun A, Bose A, Stanford FC, Carmine B, Misra M. Effects of Sleeve Gastrectomy on Bone Marrow Adipose Tissue in Adolescents and Young Adults with Obesity. J Clin Endocrinol Metab 2020; 105:5895514. [PMID: 32827034 PMCID: PMC7494241 DOI: 10.1210/clinem/dgaa581] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Sleeve gastrectomy (SG), the most common metabolic and bariatric surgery in adolescents, is associated with bone loss. Marrow adipose tissue (MAT) is a dynamic endocrine organ that responds to changes in nutrition and might serve as a novel biomarker for bone health. Two types of MAT have been described, which differ in anatomic location-proximal regulated MAT vs distal constitutive MAT. OBJECTIVE To determine the effects of SG on volumetric bone mineral density (vBMD) and MAT in adolescents with obesity. We hypothesized that SG would lead to a decrease in vBMD and differential changes in MAT. DESIGN 12-month prospective study in 52 adolescents with moderate-to-severe obesity (38 female; mean age:17.5 ± 2.2 years; mean BMI 45.2 ± 7.0 kg/m2), comprising 26 subjects before and after SG and 26 nonsurgical controls. MAIN OUTCOME MEASURES Lumbar vBMD by quantitative computed tomography; MAT of the lumbar spine, femur and tibia by proton magnetic resonance spectroscopy; abdominal fat and thigh muscle by magnetic resonance imaging. RESULTS Adolescents lost 34.1 ± 13.1 kg after SG vs 0.3 ± 8.4 kg in the control group (P < 0.001). Lumbar vBMD decreased in the SG group (P = 0.04) and this change was associated with a reduction in weight and muscle area (P < 0.05) and an increase in lumbar MAT (P = 0.0002). MAT of the femur and tibia decreased after SG vs controls (P < 0.05); however, the differences were no longer significant after controlling for change in weight. CONCLUSION SG in adolescents decreased lumbar vBMD associated with an increase in lumbar MAT and decrease in extremity MAT. This demonstrates differential changes of regulated MAT in the lumbar spine and constitutive MAT in the distal skeleton in adolescents in response to SG.
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Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Miriam A. Bredella, MD, Massachusetts General Hospital, Yawkey 6E, 55 Fruit Street, Boston, MA 02114, USA. E-mail:
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- MGH Weight Center, Boston, Massachusetts
| | - Nazanin Hazhir Karzar
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Abisayo Animashaun
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amita Bose
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Fatima C Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- MGH Weight Center, Boston, Massachusetts
| | - Brian Carmine
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Swafford AA, Ard JD, Beavers DP, Gearren PC, Fernandez AZ, Ford SA, Greene KA, Kammire DE, Nesbit BA, Reed KK, Weaver AA, Beavers KM. Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial. JBMR Plus 2020; 4:e10407. [PMID: 33103032 PMCID: PMC7574708 DOI: 10.1002/jbm4.10407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence implicates bariatric surgery as a cause of increased skeletal fragility and fracture risk. Bisphosphonate therapy reduces osteoporotic fracture risk and may be effective in minimizing bone loss associated with bariatric surgery. The main objective of this pilot randomized controlled trial (RCT; Clinical Trial No. NCT03411902) was to determine the feasibility of recruiting, treating, and following 24 older patients who had undergone sleeve gastrectomy in a 6 month RCT examining the efficacy of 150‐mg once‐monthly risedronate (versus placebo) in the prevention of surgical weight‐loss–associated bone loss. Feasibility was defined as: (i) >30% recruitment yield, (ii) >80% retention, (iii) >80% pills taken, (iv) <20% adverse events (AEs), and (v) >80% participant satisfaction. Study recruitment occurred over 17 months. Seventy participants were referred, with 24 randomized (34% yield) to risedronate (n = 11) or placebo (n = 13). Average age was 56 ± 7 years, 83% were female (63% postmenopausal), and 21% were black. The risedronate group had a higher baseline BMI than the placebo group (48.1 ± 7.2 versus 41.9 ± 3.8 kg/m2). The 10‐year fracture risk was low (6.0% major osteoporotic fracture, 0.4% hip fracture); however, three individuals (12.5%, all risedronate group) were osteopenic at baseline. Twenty‐one participants returned for 6‐month follow‐up testing (88% retention) with all (n = 3) loss to follow‐up occurring in the risedronate group. Average number of pills taken among completers was 5.9 ± 0.4 and 6.0 ± 0.0 in the risedronate and placebo groups, respectively (p = 0.21), with active participants taking >80% of allotted pills. Five AEs (3.7% AE rate) were reported; one definitely related, four not related, and none serious. All participants reported high satisfaction with participation in the study. Use of bisphosphonates as a novel therapeutic to preserve bone density in patients who had undergone a sleeve gastrectomy appears feasible and well‐tolerated. Knowledge gained from this pilot RCT will be used to inform the design of an appropriately powered trial. Clinical Trial Registration http://clinicaltrials.gov/show/NCT03411902. Weight Loss With Risedronate for Bone Health. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ashlyn A Swafford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Jamy D Ard
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Daniel P Beavers
- Department of Biostatistics and Data Science Wake Forest School of Medicine Winston-Salem NC USA
| | - Peri C Gearren
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Adolfo Z Fernandez
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Sherri A Ford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Katelyn A Greene
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Daniel E Kammire
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Beverly A Nesbit
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Kylie K Reed
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Ashley A Weaver
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Kristen M Beavers
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
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Chen X, Zhang C, Li J, Liu W, Zhang J, Zhou Z. Effects of Laparoscopic Sleeve Gastrectomy on Bone Mineral Density and Bone Metabolism in Chinese Patients with Obesity. Diabetes Metab Syndr Obes 2020; 13:4095-4103. [PMID: 33149649 PMCID: PMC7605606 DOI: 10.2147/dmso.s274614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/30/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Laparoscopic sleeve gastrectomy (LSG) is one of the most effective therapies to treat obesity. Due to a lack of longitudinal research, we explored the changes in BMD and bone metabolism in Chinese patients with obesity before and after LSG. MATERIALS AND METHODS A total of 49 obese Chinese patients with obesity were recruited from the Second Xiangya Hospital of Central South University. All patients underwent LSG, and the metabolic indicators were evaluated, including the serum osteocalcin (OC), total-terminal propeptide of type I procollagen (TPINP) and carboxy terminal telopeptide of collagen type I (CTX) levels at baseline and 2, 6 and 12 months postoperatively. Dual energy X-ray absorptiometry (DEXA) was used to measure body composition and BMD before and 12 months after LSG. RESULTS The body mass index (BMI) significantly decreased at 12 months postoperatively, and no patients developed osteoporosis. The BMD of femoral neck and total hip significantly decreased from the baseline to 12 months postoperatively, while the BMD of lumbar spine did not change significantly. The OC, TPINP and CTX levels significantly increased at 12 months postoperatively. The excess BMI loss (EBMIL) was positively related while the reduction in visceral adipose tissue (VAT) mass was negatively related to the decreases in BMD of the femoral neck and total hip at 12 months postoperatively. The increase in OC was negatively correlated with the decrease in BMD of the femoral neck, while the increase in TPINP was positively correlated with the decrease in BMD of total hip. CONCLUSION Based on the 12-month follow-up results, the BMD of the femoral neck and total hip was decreased in Chinese patients with obesity after LSG, while bone remodelling was active. This finding suggested that weight loss, a decrease in the VAT mass and an increase in bone remodelling may be correlated with a reduction in BMD.
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Affiliation(s)
- Xi Chen
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Chunlan Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Jingping Li
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Wei Liu
- Department of Metabolic Surgery, Department of Biliopancreatic Surgery, The Second Xiangya Hospital, Central South University, Changsha410011, Hunan, People’s Republic of China
| | - Jingjing Zhang
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
- Correspondence: Jingjing Zhang National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China Email
| | - Zhiguang Zhou
- National Clinical Research Center for Metabolic Diseases, Metabolic Syndrome Research Center, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha410011, Hunan, People’s Republic of China
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