1
|
Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf HJ. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. Int J Obes (Lond) 2024; 48:575-583. [PMID: 38177697 DOI: 10.1038/s41366-023-01453-8] [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] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. METHODS Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. RESULTS In cases (RYGB: mean age 26.8 ± 1.9 years, mean BMI 42.1 ± 9.9 kg/m2, VSG: mean age 25.1 ± 2.1 years, mean BMI 37.1 ± 8.4 kg/m2), compared to controls (mean age 26.5 ± 2.7 years, mean BMI 40.2 ± 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and -6.3%), femoral neck (-9.6% and -5.7%) and ultra-distal radius (-7.9% and -7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and -26%) and VSG (-15% and -14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS. CONCLUSION BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.
Collapse
Affiliation(s)
- Halley Wasserman
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Todd Jenkins
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas Inge
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Justin Ryder
- Department of Surgery, Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Marc Michalsky
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Stephanie Sisley
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- ARS/USDA Children's Nutrition Research Center, Houston, TX, USA
| | - Changchun Xie
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
2
|
Mitchell DM, Singhal V, Nimmala S, Lauze M, Bouxsein ML, Misra M, Bredella MA. Risk of wrist fracture, estimated by the load-to-strength ratio, declines following sleeve gastrectomy in adolescents and young adults. Osteoporos Int 2024; 35:285-291. [PMID: 37864596 DOI: 10.1007/s00198-023-06941-1] [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: 04/13/2023] [Accepted: 10/04/2023] [Indexed: 10/23/2023]
Abstract
To understand whether the bone loss which occurs after vertical sleeve gastrectomy increases the risk of fracture, we used an engineering model to estimate risk in participants before and after surgery. We found that estimated risk decreased 1 year after surgery and remained lower, though had rebounded, at year 2. PURPOSE Vertical sleeve gastrectomy (VSG) improves metabolic health in young people with obesity but is accompanied by substantial loss of bone mass and estimated bone strength. We thus estimated fracture risk following VSG using the load-to-strength ratio (LSR), which integrates bone strength estimates with the predicted force of a fall. METHODS Prospective 2-year study of youth ages 13-24 years with obesity undergoing VSG (n = 24) or lifestyle therapy (n = 34). We performed high-resolution peripheral quantitative computed tomography of the distal radius and microfinite element analysis to estimate bone strength and calculated LSR. RESULTS VSG participants lost 26.4 ± 8.1% weight at year 1 (p < 0.001), which was sustained at year 2, while control participants gained weight at year 2 (4.5 ± 8.3%, p = 0.009). The predicted impact force decreased at years 1 and 2 following VSG (p < 0.001) but increased at year 2 among controls (p = 0.011). Estimated bone strength was unchanged at year 1 but decreased (p < 0.001) at year 2 following VSG, while bone strength did not change in controls. At year 1, the LSR decreased among VSG participants (p < 0.001), implying a lower risk of fracture. At year 2, the LSR was lower than baseline (p < 0.001), but higher compared to year 1 (p = 0.001). LSR did not change in the control group. CONCLUSIONS Short-term estimated fracture risk at the radius following VSG decreases. However, ongoing bone loss despite stable weight between years 1 and 2 leads to a concerning rise in estimated fracture risk. Longer follow-up will be critical to evaluate the trajectory of fracture risk. (ClinicalTrials.gov NCT02557438, registered 9/23/2015).
Collapse
Affiliation(s)
- Deborah M Mitchell
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Vibha Singhal
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
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.
Collapse
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.)
| |
Collapse
|
4
|
Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S, Xie C, Kalkwarf H. Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers. RESEARCH SQUARE 2023:rs.3.rs-3345103. [PMID: 37790519 PMCID: PMC10543495 DOI: 10.21203/rs.3.rs-3345103/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Objective Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. Methods Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. Results Compared to controls, adjusted mean DXA-BMD of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and - 6.3%), femoral neck (-9.6% and - 5.7%) and ultra-distal radius (-7.9% and - 7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and - 26%) and VSG (-15% and - 14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MSB were not associated with bone measures at a median of 9.3 years post MSB. Conclusion BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck decreased with time since MBS but were not associated with BMI change.
Collapse
Affiliation(s)
| | | | | | | | - Marc Michalsky
- Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, Columbus, Ohio
| | | | | | - Heidi Kalkwarf
- Cincinnati Children's Hospital Medical Center, Cincinatti OH
| |
Collapse
|
5
|
Haines MS, Kaur S, Scarff G, Lauze M, Gerweck A, Slattery M, Oreskovic NM, Ackerman KE, Tenforde AS, Popp KL, Bouxsein ML, Miller KK, Misra M. Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes. J Clin Endocrinol Metab 2023; 108:e1063-e1073. [PMID: 37079740 PMCID: PMC10505543 DOI: 10.1210/clinem/dgad215] [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: 10/17/2022] [Revised: 12/19/2022] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
CONTEXT Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners. OBJECTIVE To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength. DESIGN Cross-sectional. SETTING Clinical research center. PARTICIPANTS 39 men (20 runners, 19 controls), ages 16-30 years. MAIN OUTCOME MEASURES Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability. RESULTS Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA CONCLUSIONS Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.
Collapse
Affiliation(s)
- Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Snimarjot Kaur
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Geetanjali Scarff
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Anu Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Nicolas M Oreskovic
- Harvard Medical School, Boston, MA 02115, USA
- Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kathryn E Ackerman
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA
| | - Adam S Tenforde
- Harvard Medical School, Boston, MA 02115, USA
- Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA 02129, USA
| | - Kristin L Popp
- Harvard Medical School, Boston, MA 02115, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Department of Energy, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
| | - Mary L Bouxsein
- Harvard Medical School, Boston, MA 02115, USA
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA 02114, USA
| |
Collapse
|
6
|
Huber FA, Singhal V, Tuli S, Becetti I, López López AP, Bouxsein ML, Misra M, Bredella MA. Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy. Radiology 2023; 307:e223256. [PMID: 37310246 PMCID: PMC10315522 DOI: 10.1148/radiol.223256] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/18/2023] [Accepted: 04/27/2023] [Indexed: 06/14/2023]
Abstract
Background Sleeve gastrectomy (SG) is effective in the treatment of cardiometabolic complications of obesity but is associated with bone loss. Purpose To determine the long-term effects of SG on vertebral bone strength, density, and bone marrow adipose tissue (BMAT) in adolescents and young adults with obesity. Materials and Methods This 2-year prospective nonrandomized longitudinal study enrolled adolescents and young adults with obesity who underwent either SG (SG group) or dietary and exercise counseling without surgery (control group) at an academic medical center from 2015 to 2020. Participants underwent quantitative CT of the lumbar spine (L1 and L2 levels) to assess bone density and strength, proton MR spectroscopy to assess BMAT (L1 and L2 levels), and MRI of the abdomen and thigh to assess body composition. Student t and Wilcoxon signed-rank tests were used to compare 24-month changes between and within groups. Regression analysis was performed to evaluate associations between body composition, vertebral bone density, strength, and BMAT. Results A total of 25 participants underwent SG (mean age, 18 years ± 2 [SD], 20 female), and 29 underwent dietary and exercise counseling without surgery (mean age, 18 years ± 3, 21 female). Body mass index (BMI) decreased by a mean of 11.9 kg/m2 ± 5.21 [SD] after 24 months in the SG group (P < .001), while it increased in the control group (mean increase, 1.49 kg/m2 ± 3.10; P = .02). Mean bone strength of the lumbar spine decreased after surgery compared with that in control subjects (mean decrease, -728 N ± 691 vs -7.24 N ± 775; P < .001). BMAT of the lumbar spine increased after SG (mean lipid-to-water ratio increase, 0.10 ± 0.13; P = .001). Changes in vertebral density and strength correlated positively with changes in BMI and body composition (R = 0.34 to R = 0.65, P = .02 to P < .001) and inversely with vertebral BMAT (R = -0.33 to R = -0.47, P = .03 to P = .001). Conclusion SG in adolescents and young adults reduced vertebral bone strength and density and increased BMAT compared with those in control participants. Clinical trial registration no. NCT02557438 © RSNA, 2023 See also the editorial by Link and Schafer in this issue.
Collapse
Affiliation(s)
- Florian A. Huber
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Vibha Singhal
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Shubhangi Tuli
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Imen Becetti
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Ana Paola López López
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Mary L. Bouxsein
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Madhusmita Misra
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| | - Miriam A. Bredella
- From the Department of Radiology (F.A.H., M.A.B.), Neuroendocrine
Unit (V.S., S.T., I.B., A.P.L.L., M.M.), and Endocrine Unit (M.L.B.),
Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey
6E, Boston, MA 02114; Institute of Diagnostic and Interventional Radiology,
University Hospital Zurich, University of Zurich, Zurich, Switzerland (F.A.H.);
Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard
Medical School, Boston, Mass (V.S., I.B., M.M.); MGH Weight Center, Boston, Mass
(V.S.); and Department of Orthopedic Surgery, Beth Israel Deaconess Medical
Center and Harvard Medical School, Boston, Mass (M.L.B.)
| |
Collapse
|
7
|
Araújo MM, Mendes MM, Costa LM, Lima RM, Lanham-New SA, Baiocchi de Carvalho KM, Botelho PB. Determinant factors of bone health after long-term of Roux-en-Y gastric bypass surgery: A cross-sectional study. Nutrition 2023; 108:111937. [PMID: 36640632 DOI: 10.1016/j.nut.2022.111937] [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: 08/29/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate bone health and the potential influencing factors of bone metabolism disorders in adults ≥5 y after Roux-en-Y gastric bypass (RYGB) surgery. METHODS In this cross-sectional study, patients who were ≥5 y post-RYGB were invited. Bone health considered as bone mineral content (BMC) and bone mineral density (BMD) in this study was assessed by dual x-ray absorptiometry. We also assessed 25-hydroxy-vitamin D concentrations, individual ultraviolet B radiation levels, serum ionized calcium, alkaline phosphatase, parathyroid, anthropometric, and body composition. RESULTS The study evaluated 104 adults (90% women; 49.6 ± 9.1 y old; postoperative period 8.7 ± 2.2 y). Lumbar and femoral BMC and BMD were positively correlated to body mass index (BMI), appendicular lean mass (ALM), and negatively to %excess of weight loss (EWL). Femoral BMD was negatively correlated to age, and both femoral BMD and BMC were positively correlated to weekly exposed body part score. Sex, age, BMI, ALM, and weekly exposed body part score explained 35% and 54% of the total variance of femoral BMD and BMC, respectively. CONCLUSIONS The present findings suggested that older age, lower BMI, higher %EWL, lower ALM, and lower weekly body part exposure score are important determinants in lowering BMD and BMC parameters in long-term post-bariatric surgery individuals, rather than serum 25-hydroxy-vitamin D and parathyroid.
Collapse
Affiliation(s)
| | | | - Lorena Morais Costa
- Graduate Program in Human Nutrition, University of Brasília, Brasília, Brazil
| | - Ricardo Moreno Lima
- Graduate Program in Human Nutrition, University of Brasília, Brasília, Brazil; Graduate Program in Physical Education, University of Brasília, Brasília, Brazil
| | - Susan A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | | | | |
Collapse
|
8
|
Zahedi B, Daley EJ, Brooks DJ, Bruce M, Townsend RL, Berthoud HR, Bouxsein ML, Yu EW. The PYY/Y2R-deficient male mouse is not protected from bone loss due to Roux-en-Y gastric bypass. Bone 2023; 167:116608. [PMID: 36368466 PMCID: PMC10064867 DOI: 10.1016/j.bone.2022.116608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Peptide YY (PYY) is an anorexigenic gut hormone that also has anti-osteogenic effects, inhibiting osteoblastic activity and inducing catabolic effects. It has been postulated that increases in PYY after Roux-en-Y gastric bypass (RYGB) contribute to declines in bone mineral density (BMD) and increases in bone turnover. The aim of this study is to determine the role of the PYY Y2-receptor in mediating bone loss post-RYGB in mice. METHODS We compared adult male wildtype (WT) and PYY Y2 receptor-deficient (KO) C57BL/6 mice that received RYGB (WT: n = 8; KO: n = 9), with sham-operated mice (Sham; WT: n = 9; KO: n = 10) and mice that were food-restricted to match the weights of the RYGB-treated group (Weight-Matched, WM; WT: n = 7; KO: n = 5). RYGB or sham surgery was performed at 15-16 weeks of age, and mice sacrificed 21 weeks later. We characterized bone microarchitecture with micro-computed tomography (μCT) at the distal femur (trabecular) and femoral midshaft (cortical). Differences in body weight, bone microarchitecture and biochemical bone markers (parathyroid hormone, PTH; C-telopeptide, CTX; and type 1 procollagen, P1NP) were compared using 2-factor ANOVA with Tukey's adjustments for multiple comparisons. RESULTS Body weights were similar in the WT-RYGB, WT-WM, KO-RYGB, and KO-WM: 41-44 g; these groups weighed significantly less than the Sham surgery groups: 55-57 g. Trabecular BMD was 31-43 % lower in RYGB mice than either Sham or WM in WT and KO groups. This deficiency in trabecular bone was accompanied by a lower trabecular number (19 %-23 %), thickness (22 %-30 %) and increased trabecular spacing (25 %-34 %) in WT and KO groups (p < 0.001 for all comparisons vs. RYGB). RYGB led to lower cortical thickness, cortical tissue mineral density, and cortical bone area fraction as compared to Sham and WM in WT and KO groups (p ≤ 0.004 for all). There were no interactions between genotype and bone microarchitecture, with patterns of response to RYGB similar in both WT and KO groups. CTX and P1NP were significantly higher in RYGB mice than WM in WT and KO groups. PTH did not differ among groups. CONCLUSIONS RYGB induced greater trabecular and cortical deficits and high bone turnover than observed in weight-matched mice, with a similar pattern in the WT and Y2RKO mice. Thus, skeletal effects of RYGB are independent of weight loss, and furthermore, PYY signaling through Y2R is not a key mediator of bone loss post-RYGB.
Collapse
Affiliation(s)
- Bita Zahedi
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America.
| | - Eileen J Daley
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Daniel J Brooks
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Michael Bruce
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - R Leigh Townsend
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, United States of America
| | - Hans-Rudolf Berthoud
- Neurobiology of Nutrition & Metabolism Department, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, United States of America
| | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, United States of America
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Lobene AJ, Panda S, Mashek DG, Manoogian ENC, Hill Gallant KM, Chow LS. Time-Restricted Eating for 12 Weeks Does Not Adversely Alter Bone Turnover in Overweight Adults. Nutrients 2021; 13:nu13041155. [PMID: 33807284 PMCID: PMC8065778 DOI: 10.3390/nu13041155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
Weight loss is a major focus of research and public health efforts. Time-restricted eating (TRE) is shown to be effective for weight loss, but the impact on bone is unclear. Short-term TRE studies show no effect on bone mineral density (BMD), but no study has measured bone turnover markers. This secondary analysis examined the effect of 12 weeks of TRE vs. unrestricted eating on bone turnover and BMD. Overweight and obese adults aged 18–65 y (n = 20) were randomized to TRE (ad libitum 8-h eating window) or non-TRE. Serum N-terminal propeptide of type I collagen (P1NP), cross-linked N-telopeptide of type I collagen (NTX), and parathyroid hormone (PTH) levels were measured and dual-energy X-ray absorptiometry (DXA) scans were taken pre- and post-intervention. In both groups, P1NP decreased significantly (p = 0.04) but trended to a greater decrease in the non-TRE group (p = 0.07). The treatment time interaction for bone mineral content (BMC) was significant (p = 0.02), such that BMC increased in the TRE group and decreased in the non-TRE group. Change in P1NP was inversely correlated with change in weight (p = 0.04) overall, but not within each group. These findings suggest that TRE does not adversely affect bone over a moderate timeframe. Further research should examine the long-term effects of TRE on bone.
Collapse
Affiliation(s)
- Andrea J. Lobene
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19713, USA
- Correspondence:
| | - Satchidananda Panda
- Salk Institute for Biological Studies, La Jolla, CA 92037, USA; (S.P.); (E.N.C.M.)
| | - Douglas G. Mashek
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
| | | | - Kathleen M. Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
| | - Lisa S. Chow
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
| |
Collapse
|
14
|
Krez A, Agarwal S, Bucovsky M, McMahon DJ, Hu Y, Bessler M, Schrope B, Carrelli A, Clare S, Guo XDE, Silverberg SJ, Stein EM. Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women. J Clin Endocrinol Metab 2021; 106:e1868-e1879. [PMID: 33098299 PMCID: PMC8502471 DOI: 10.1210/clinem/dgaa654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN Four-year prospective cohort study. PATIENTS African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.
Collapse
Affiliation(s)
- Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mariana Bucovsky
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Beth Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Carrelli
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shannon Clare
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Shonni J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Correspondence and Reprint Requests: Emily M. Stein, MD, MS, Director of Research, Metabolic Bone Service, Hospital for Special Surgery, Associate Professor of Medicine, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021. E-mail:
| |
Collapse
|
15
|
Zoledronic acid for prevention of bone loss in patients receiving bariatric surgery. Bone Rep 2021; 14:100760. [PMID: 33816718 PMCID: PMC8005765 DOI: 10.1016/j.bonr.2021.100760] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
Purpose Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to examine the preliminary safety and efficacy of zoledronic acid (ZOL), a potent anti-resorptive bisphosphonate, to suppress bone turnover markers (BTM) and prevent declines in bone mineral density (BMD) after Roux-en-Y gastric bypass (RYGB) surgery. Methods We performed an open-label pilot study of pre-operative ZOL in postmenopausal women with obesity who were planning RYGB (n = 4). A single dose of zoledronic acid 5 mg was given intravenously prior to RYGB. Serum bone biochemistries including C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at multiple timepoints throughout the 24-week study. BMD was also obtained at the spine and hip by dual-energy x-ray absorptiometry (DXA) and at the trabecular spine by quantitative computed tomography (QCT) at pre-operative baseline and 24 weeks. Results were compared against pre-operative baseline and against changes among RYGB historical controls (n = 10). Results At 2 weeks after RYGB, there was a nonsignificant trend for CTX and P1NP levels to be lower than baseline levels in the ZOL group. By 24 weeks after RYGB, however, participants who received ZOL had a significant increase in CTX above pre-operative baseline (+0.228 ± 0.117 ng/dL, p = 0.030) but this CTX rise was less than that observed in the controls (+0.601 ± 0.307 ng/dL, p = 0.042 between groups). Despite ZOL use, participants had significant areal BMD loss at the total hip as compared to pre-operative baseline (-4.2 ± 1.5%, p = 0.012) that was similar in magnitude to total hip BMD loss in the controls (-5.5 ± 3.9%, p = 0.005). There was a suggestion that the ZOL group might be protected against trabecular spine volumetric bone loss as compared to the control group (+4.8 ± 8.0% vs. -5.9 ± 7.0%, p = 0.075 between groups). Serum calcium, 25-hydroxyvitamin D, and parathyroid hormone did not change in either group. No hypocalcemia or serious adverse events were reported after ZOL. Conclusion In this proof of concept study, a single dose of ZOL prior to RYGB appeared to transiently mitigate but not fully prevent high bone turnover in the acute postoperative period. At 24 weeks after RYGB, our preliminary data suggest that ZOL was not sufficient to prevent bone loss at the hip, although it may preserve bone density at the trabecular spine. Further prospective, controlled studies are needed to confirm our findings and to identify the best strategies for preventing bone loss in bariatric patients receiving RYGB.
Collapse
|
16
|
Lewis JR, Voortman T, Ioannidis JP. Evaluating and Strengthening the Evidence for Nutritional Bone Research: Ready to Break New Ground? J Bone Miner Res 2021; 36:219-226. [PMID: 33503301 DOI: 10.1002/jbmr.4236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 01/19/2023]
Abstract
A healthy diet is essential to attain genetically determined peak bone mass and maintain optimal skeletal health across the adult lifespan. Despite the importance of nutrition for bone health, many of the nutritional requirements of the skeleton across the lifespan remain underexplored, poorly understood, or controversial. With increasingly aging populations, combined with rapidly changing diets and lifestyles globally, one anticipates large increases in the prevalence of osteoporosis and incidence of osteoporotic fractures. Robust, transparent, and reproducible nutrition research is a cornerstone for developing reliable public health recommendations to prevent osteoporosis and osteoporotic fractures. However, nutrition research is often criticized or ignored by healthcare professionals due to the overemphasis of weak science, conflicting, confusing or implausible findings, industry interests, common misconceptions, and strong opinions. Conversely, spurious research findings are often overemphasized or misconstrued by the media or prominent figures especially via social media, potentially leading to confusion and a lack of trust by the general public. Recently, reforms of the broader discipline of nutrition science have been suggested and promoted, leading to new tools and recommendations to attempt to address these issues. In this perspective, we provide a brief overview of what has been achieved in the field on nutrition and bone health, focusing on osteoporosis and osteoporotic fractures. We discuss what we view as some of the challenges, including inherent difficulties in assessing diet and its change, disentangling complex interactions between dietary components and between diet and other factors, selection of bone-related outcomes for nutrition studies, obtaining evidence with more unbiased designs, and perhaps most importantly, ensuring the trust of the public and healthcare professionals. This perspective also provides specific recommendations and highlights new developments and future opportunities for scientists studying nutrition and bone health. © 2021 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Joshua R Lewis
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,Medical School, The University of Western Australia, Perth, WA, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - John Pa Ioannidis
- Department of Medicine, Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.,Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.,Department of Biomedical Data Science, Stanford University, Stanford, CA, USA.,Department of Statistics, Stanford University, Stanford, CA, USA.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
| |
Collapse
|
17
|
Abstract
The COVID-19 pandemic has broad implications for the care of patients with bone fragility. A dramatic surge in fractures and related mortality is expected in the next few months. We pledge to intensify the current efforts to improve the management of bone health, and to prioritize fragility fracture care and prevention.
Collapse
Affiliation(s)
- Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA.
| | - Ann L Elderkin
- American Society for Bone and Mineral Research, Washington, DC, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Sundeep Khosla
- Kogod Center on Aging and Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|