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de Almeida PC, Lima TDR, Avila ETP, Damazo AS. Short-term effects of Roux-en-Y gastric bypass or gastric sleeve on bone mineral density and calciotropic hormones: a systematic review and meta-analysis. Surg Obes Relat Dis 2024; 20:774-783. [PMID: 38594090 DOI: 10.1016/j.soard.2024.03.007] [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: 09/18/2023] [Revised: 01/28/2024] [Accepted: 03/02/2024] [Indexed: 04/11/2024]
Abstract
Roux-en-Y gastric bypass (RYGB) and gastric sleeve (GS) have been associated with significant reductions in bone mineral density (BMD) and fluctuations in serum levels of calciotropic hormones. These changes pose a risk to bone health. The study assessed the short-term (12 and 24 months) effects of RYGB and GS on BMD and calciotropic hormones. PubMed, Embase, and Cochrane Library databases were searched. Analyses considered follow-up (12 and 24 months) with BMD as main outcome at three sites (femoral neck, total hip, and lumbar spine) and one for each calciotropic hormone (25 OH vitamin D and parathyroid hormone [PTH]). Estimated effect sizes were calculated as standardized mean differences (SMD), confidence interval of 95%, and P value. Nine studies totaling 473 participants (RYGB = 261 and GS = 212) were included. RYGB resulted in lower BMD than GS at 12 months for femoral neck (SMD = -0.485, 95% CI [-0.768, -0.202], P = .001), lumbar spine (SMD = -0.471, 95% CI [-0.851, -0.092], P = .015), and total hip (SMD = -0.616, 95% CI [-0.972, -0.259], P = .001), and at 24 months for total hip (SMD = -0.572, 95% CI [-0.907, -0.238], P = .001). At 24 months, 25 OH vitamin D was lower in RYGB than GS (SMD = -0.958 [-1.670, -0.245], P = .008) and PTH levels were higher in RYGB than in GS (SMD = 0.968 [0.132, 1.804, P = .023]). RYGB demonstrated significant reduction in regional BMD. It also induces lower serum 25 OH vitamin D and higher PTH levels than GS. The results support the need for preventive bone health measures in the short-term postoperative period, especially in the case of RYGB.
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Affiliation(s)
- Paula Caroline de Almeida
- Faculty of Medicine, Federal University of Mato Grosso, Brazil, Postgraduate Program in Health Sciences, Cuiabá, Mato Grosso, Brazil
| | - Thiago da Rosa Lima
- Faculty of Medicine, Federal University of Mato Grosso, Brazil, Postgraduate Program in Health Sciences, Cuiabá, Mato Grosso, Brazil; Faculty of Medicine, University Center of Várzea Grande - UNIVAG, Várzea Grande, Mato Grosso, Brazil.
| | - Eudes Thiago Pereira Avila
- Faculty of Medicine, Federal University of Mato Grosso, Brazil, Postgraduate Program in Health Sciences, Cuiabá, Mato Grosso, Brazil
| | - Amílcar Sabino Damazo
- Faculty of Medicine, Federal University of Mato Grosso, Brazil, Postgraduate Program in Health Sciences, Cuiabá, Mato Grosso, Brazil
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Nie M, Zhang J, Bal M, Duran C, An SW, Zigman JM, Baum M, Hiremath C, Marciano DK, Wolf MTF. Ghrelin enhances tubular magnesium absorption in the kidney. Front Physiol 2024; 15:1363708. [PMID: 38638279 PMCID: PMC11024433 DOI: 10.3389/fphys.2024.1363708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024] Open
Abstract
Osteoporosis after bariatric surgery is an increasing health concern as the rate of bariatric surgery has risen. In animal studies mimicking bariatric procedures, bone disease, together with decreased serum levels of Ca2+, Mg2+ and the gastric hormone Ghrelin were described. Ghrelin regulates metabolism by binding to and activating the growth hormone secretagogue receptor (GHSR) which is also expressed in the kidney. As calcium and magnesium are key components of bone, we tested the hypothesis that Ghrelin-deficiency contributes to osteoporosis via reduced upregulation of the renal calcium channel TRPV5 and the heteromeric magnesium channel TRPM6/7. We expressed GHSR with TRPV5 or TRPM6/7 channel in HEK293 cells and treated them with purified Ghrelin. Whole-cell current density was analyzed by patch-clamp recording. Nephron-specific gene expression was performed by tubular microdissection followed by qPCR in wild-type (WT) mice, and immunofluorescent imaging of GHSR-eGFP mice. Tubular magnesium homeostasis was analyzed in GHSR-null and WT mice at baseline and after caloric restriction. After Ghrelin exposure, whole-cell current density did not change for TRPV5 but increased for TRPM6/7 in a dose-dependent fashion. Applying the Ghrelin-mimetic (D-Trp7, Ala8,D-Phe10)-α-MSH (6-11) amide without and with the GHSR antagonist (D-Lys3)-GHRP6, we confirmed the stimulatory role of Ghrelin towards TRPM6/7. As GHSR initiates downstream signaling via protein kinase A (PKA), we found that the PKA inhibitor H89 abrogated TRPM6/7 stimulation by Ghrelin. Similarly, transfected Gαs, but not the Gαs mutant Q227L, nor Gαi2, Gαq, or Gα13 upregulated TRPM6/7 current density. In microdissected TALs and DCTs similar levels of GHSR mRNA were detected. In contrast, TRPM6 mRNA was expressed in the DCT and also detected in the TAL at 25% expression compared to DCT. Immunofluorescent studies using reporter GHSR-eGFP mice showed a strong eGFP signal in the TAL but surprisingly displayed no eGFP signal in the DCT. In 3-, 6-, and 9-month-old GHSR-null and WT mice, baseline serum magnesium was not significantly different, but 24-h urinary magnesium excretion was elevated in 9-month-old GHSR-null mice. In calorically restricted GHSR-null mice, we detected excess urinary magnesium excretion and reduced serum magnesium levels compared to WT mice. The kidneys from calorically restricted WT mice showed upregulated gene expression of magnesiotropic genes Hnf1b, Cldn-16, Cldn-19, Fxyd-2b, and Parvalbumin compared to GHSR-null mice. Our in vitro studies show that Ghrelin stimulates TRPM6/7 via GHSR and Gαs-PKA signaling. The murine studies are consistent with Ghrelin-GHSR signaling inducing reduced urinary magnesium excretion, particularly in calorically restricted mice when Ghrelin levels are elevated. This effect may be mediated by Ghrelin-upregulation of TRPM6 in the TAL and/or upregulation of other magnesiotropic genes. We postulate that rising Ghrelin levels with hunger contribute to increased renal Mg2+ reabsorption to compensate for lack of enteral Mg2+ uptake.
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Affiliation(s)
- Mingzhu Nie
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jing Zhang
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Manjot Bal
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Claudia Duran
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Sung Wan An
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Jeffrey M. Zigman
- Department of Internal Medicine, Center for Hypothalamic Research, UTSW Medical Center, Dallas, TX, United States
| | - Michel Baum
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Chitkale Hiremath
- Department of Internal Medicine, Nephrology, and Department of Cell Biology, UTSW Medical Center, Dallas, TX, United States
| | - Denise K. Marciano
- Department of Internal Medicine, Nephrology, and Department of Cell Biology, UTSW Medical Center, Dallas, TX, United States
| | - Matthias T. F. Wolf
- Pediatric Nephrology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
- Pediatric Nephrology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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Jadzic J, Andjelic U, Milovanovic P, Zivkovic V, Nikolic S, Djonic D, Djuric M. Improved femoral micro-architecture in adult male individuals with overweight: fracture resistance due to regional specificities. Int J Obes (Lond) 2024; 48:202-208. [PMID: 37770573 DOI: 10.1038/s41366-023-01389-z] [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: 05/28/2023] [Revised: 09/16/2023] [Accepted: 09/22/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND It is still unclear whether femoral fracture risk is positively or negatively altered in individuals with overweight. Considering the lack of studies including men with overweight, this study aimed to analyze regional specificities in mechano-structural femoral properties (femoral neck and intertrochanteric region) in adult male cadavers with overweight compared to their normal-weight age-matched counterparts. METHODS Ex-vivo osteodensitometry, micro-computed tomography, and Vickers micro-indentation testing were performed on femoral samples taken from 30 adult male cadavers, divided into the group with overweight (BMI between 25 and 30 kg/m2; n = 14; age:55 ± 16 years) and control group (BMI between 18.5 and 25 kg/m2; n = 16; age:51 ± 18 years). RESULTS Better quality of trabecular and cortical microstructure in the inferomedial (higher trabecular bone volume fraction, trabecular thickness, and cortical thickness, coupled with reduced cortical pore diameter, p < 0.05) and superolateral femoral neck (higher trabecular number and tendency to lower cortical porosity, p = 0.043, p = 0.053, respectively) was noted in men with overweight compared to controls. Additionally, the intertrochanteric region of men with overweight had more numerous and denser trabeculae, coupled with a thicker and less porous cortex (p < 0.05). Still, substantial overweight-induced change in femoral osteodensitometry parameters and Vickers micro-hardness was not demonstrated in assessed femoral subregions (p > 0.05). CONCLUSIONS Despite the absence of significant changes in femoral osteodensitometry, individuals with overweight had better trabecular and cortical femoral micro-architecture implying higher femoral fracture resistance. However, the microhardness was not significantly favorable in the individuals who were overweight, indicating the necessity for further research.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Uros Andjelic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Milovanovic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Zivkovic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Slobodan Nikolic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
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Folli F, Finzi G, Manfrini R, Galli A, Casiraghi F, Centofanti L, Berra C, Fiorina P, Davalli A, La Rosa S, Perego C, Higgins PB. Mechanisms of action of incretin receptor based dual- and tri-agonists in pancreatic islets. Am J Physiol Endocrinol Metab 2023; 325:E595-E609. [PMID: 37729025 PMCID: PMC10874655 DOI: 10.1152/ajpendo.00236.2023] [Citation(s) in RCA: 1] [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: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/22/2023]
Abstract
Simultaneous activation of the incretin G-protein-coupled receptors (GPCRs) via unimolecular dual-receptor agonists (UDRA) has emerged as a new therapeutic approach for type 2 diabetes. Recent studies also advocate triple agonism with molecules also capable of binding the glucagon receptor. In this scoping review, we discuss the cellular mechanisms of action (MOA) underlying the actions of these novel and therapeutically important classes of peptide receptor agonists. Clinical efficacy studies of several UDRAs have demonstrated favorable results both as monotherapies and when combined with approved hypoglycemics. Although the additive insulinotropic effects of dual glucagon-like peptide-1 receptor (GLP-1R) and glucose-dependent insulinotropic peptide receptor (GIPR) agonism were anticipated based on the known actions of either glucagon-like peptide-1 (GLP-1) or glucose-dependent insulinotropic peptide (GIP) alone, the additional benefits from GCGR were largely unexpected. Whether additional synergistic or antagonistic interactions among these G-protein receptor signaling pathways arise from simultaneous stimulation is not known. The signaling pathways affected by dual- and tri-agonism require more trenchant investigation before a comprehensive understanding of the cellular MOA. This knowledge will be essential for understanding the chronic efficacy and safety of these treatments.
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Affiliation(s)
- Franco Folli
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- Unit of Diabetes, Endocrinology and Metabolism, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Giovanna Finzi
- Unit of Pathology, Department of Oncology, ASST Sette Laghi, Varese, Italy
| | - Roberto Manfrini
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
- Unit of Diabetes, Endocrinology and Metabolism, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Alessandra Galli
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Francesca Casiraghi
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Lucia Centofanti
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy
| | - Cesare Berra
- IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Paolo Fiorina
- International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC, Università di Milano, Milan, Italy
- Nephrology Division, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alberto Davalli
- Diabetes and Endocrinology Unit, Department of Internal Medicine, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano La Rosa
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Carla Perego
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy
| | - Paul B Higgins
- Department of Life & Physical Sciences, Atlantic Technological University, Letterkenny, Ireland
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Huber FA, Singhal V, Tuli S, Stanford FC, Carmine B, Bouxsein ML, Misra M, Bredella MA. Biomechanical CT to Assess Bone After Sleeve Gastrectomy in Adolescents With Obesity: A Prospective Longitudinal Study. J Bone Miner Res 2023; 38:933-942. [PMID: 37073493 PMCID: PMC10363214 DOI: 10.1002/jbmr.4784] [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: 11/10/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
Sleeve gastrectomy (SG) is effective in treating cardiometabolic complications of obesity but is associated with bone loss. Our aim was to determine the effect of SG on the lumbar spine by biomechanical CT analysis in adolescents/young adults with obesity. We hypothesized that SG would lead to a decrease in strength and bone mineral density (BMD) compared with nonsurgical controls. In a 12-month prospective nonrandomized study, adolescents/young adults with obesity underwent SG (n = 29, 18.0 ± 2.1 years, 23 female) or were followed without surgery (controls, n = 30, 17.95 ± 3.0 years, 22 female). At baseline and 12 months, participants underwent quantitative computed tomography (QCT) of L1 and L2 for biomechanical assessment and MRI of the abdomen and mid-thigh for body composition assessment. Twelve-month changes between groups and within groups were assessed. Analyses were controlled for baseline and 12-month changes in body mass index (BMI) by multivariable analyses. Regression analysis was performed to evaluate the effect of body composition on bone parameters. Our institutional review board (IRB) approved the study, and informed consent/assent was obtained. Participants in the SG group had a higher baseline BMI than controls (p = 0.01) and lost an average of 34.3 ± 13.6 kg 12 months after surgery, whereas weight was unchanged in controls (p < 0.001). There were significant reductions in abdominal adipose tissue and thigh muscle area in the SG group compared with controls (p < 0.001). Bone strength, bending stiffness, and average and trabecular volumetric BMD decreased in the SG group compared with controls (p < 0.001). After controlling for change in BMI, a 12-month reduction in cortical BMD was significant in the SG group compared with controls (p = 0.02). Reductions in strength and trabecular BMD were associated with reductions in BMI, visceral adipose tissue, and muscle (p ≤ 0.03). In conclusion, SG in adolescents decreased strength and volumetric BMD of the lumbar spine compared with nonsurgical controls. These changes were associated with decreases in visceral fat and muscle mass. © 2023 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Florian A. Huber
- Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- MGH Weight Center, Boston, Massachusetts
| | - Shubhangi Tuli
- 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
- Division of Pediatric Endocrinology, 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
| | - Mary L. Bouxsein
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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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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7
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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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8
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Nimmala S, Kaur S, Singhal V, Mitchell DM, Stanford FC, Bouxsein ML, Lauze M, Huynh C, Pedreira CC, Lee H, Bredella MA, Misra M. Changes in Sex Steroids and Enteric Peptides After Sleeve Gastrectomy in Youth in Relation to Changes in Bone Parameters. J Clin Endocrinol Metab 2022; 107:e3747-e3758. [PMID: 35689793 PMCID: PMC9387701 DOI: 10.1210/clinem/dgac361] [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: 03/11/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT Sleeve gastrectomy (SG) improves metabolic endpoints but is associated with impaired bone outcomes. OBJECTIVE To determine mechanisms contributing to impaired bone health in youth following SG. METHODS 12-month longitudinal observational study in a multidisciplinary tertiary-care hospital, including 64 youth 13-25 years old with moderate-to-severe obesity (51 females); 30 underwent SG and 34 were nonsurgical (NS) controls. SG was undertaken after a combined decision-making process between treatment team and patient. The main outcome measures were fasting blood for enteric peptides, sex steroids, sclerostin, and bone turnover markers (N-terminal propeptide of type 1 procollagen [P1NP] and C-terminal cross-linking telopeptide [CTX]); dual-energy X-ray absorptiometry measures of areal bone mineral density (aBMD) and body composition; high resolution peripheral quantitative computed tomography; measures of volumetric BMD (vBMD); microfinite element analysis of strength estimates (distal radius and tibia). RESULTS SG had greater reductions in body mass index (BMI) z-scores, serum estrone, and the free androgen index (FAI) (P ≤ .046), and greater increases in sclerostin, P1NP, and CTX (P ≤ .010) than NS controls. Fasting ghrelin decreased in SG vs NS (P < .0001); fasting peptide YY did not change. Most changes were driven by female SG participants. Among females (the majority of study participants), after controlling for baseline age and race, reductions in total hip aBMD Z-scores were positively associated with changes in BMI, lean mass, estrone, FAI, and ghrelin, and inversely with changes in sclerostin.. Decreases in total vBMD of the radius and tibia were associated positively with decreases in BMI. Increases in CTX were associated with decreases in BMI, lean mass, and ghrelin, and increases in sclerostin. CONCLUSION Bone loss after SG in youth is associated with changes in body composition, sex steroids, sclerostin, and enteric peptides. These are potential targets for future preventative or therapeutic strategies.
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Affiliation(s)
- Supritha Nimmala
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Snimarjot Kaur
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- MGH Weight Center, Boston, MA 02114, USA
| | - Deborah M Mitchell
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Fatima Cody Stanford
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- MGH Weight Center, Boston, MA 02114, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Meghan Lauze
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Carolyn Huynh
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Clarissa C Pedreira
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Hang Lee
- MGH Biostatistics Center and Harvard Medical School, Boston, MA 02114, USA
- Department of Medicine and Harvard Medical School, Boston, MA 02114, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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9
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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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10
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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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11
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Understanding the Experience of Osteoporosis Risk in Bariatric Surgical Patients. Orthop Nurs 2021; 40:222-234. [PMID: 34397978 DOI: 10.1097/nor.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Despite what is known about risk factors, preventive treatment, and increased prevalence of fragility fractures in post-bariatric surgical patients, little is known about how patient perspectives of osteoporosis risk inform their commitment to bone health. The purpose of this study was to examine the lived experience of osteoporosis risk in people who have had bariatric surgery. Interpretive phenomenology was used to explore osteoporosis from the perspectives of patients who have had bariatric surgery. Eligibility criteria included female, age older than 18 years, and able to understand and speak English. This research provided an understanding of the risk of osteoporosis from the constructed realities and experiences of those who have had bariatric surgery. Participants in this study incorrectly felt they had little to no risk for osteoporosis after bariatric surgery. Patients need to be aware of an increased risk for osteoporosis leading to the potential for fragility fractures after bariatric surgery; nurses are well positioned to enhance osteoporosis prevention efforts in this population through pre- and postoperative education.
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12
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Volonakis S, Koika V, Tzavelas G, Skopeliti M, Skroubis G, Kalfarentzos F, Alexandrides T. Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women. Hormones (Athens) 2021; 20:315-321. [PMID: 33155141 DOI: 10.1007/s42000-020-00254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study is to investigate the effect of adequate vitamin D supplementation on bone mineral density (BMD) following long limb-biliopancreatic diversion (LL-BPD), a malabsorptive bariatric operation. BACKGROUND Marked weight loss following bariatric surgery is associated with significant decrease in BMD, attributed to the weight loss and to nutritional, mineral, and vitamin D deficiencies resulting in secondary hyperparathyroidism. METHODS Two groups, of 35 and 37 healthy, obese (BMI, 50.4 + 6.6 and 46.5 + 4.8 g/cm2), premenopausal, normally menstruating women underwent LL-BPD. Both groups received high-calcium diets, 600 IU of vitamin D, and 1000 mg elemental calcium daily, while group B received an extra dose of vitamin D (10,000 IU/day) during the first postoperative month, followed by dose adjustment in order to maintain 25OHD concentration higher than 30 μg/L. Areal BMD (aBMD) was measured at the lumbar spine preoperatively and 1 year postoperatively. RESULTS One year postoperatively, BMI decreased by approximately 19 kg/m2 in both groups, while 25-OH-vitamin D levels did not change in group A (18.7 + 9.1 to 20.2 + 13.0 μg/L, (p = 0.57)) and increased in group B (15.58 ± 5.73 to 52.97 ± 15.46 μg/L, (p = < 0.001). PTH levels increased in group A (from 38.5 ± 12.2 to 51.2 ± 32.8 pg/ml) (p = 0.047) and decreased in group B (from 51.61 ± 18.7 to 45.1 ± 17.8 pg/ml) (p = 0.042). Lumbar spine aBMD decreased similarly in both groups (p = 0.311, for the comparison between groups) from 1.198 + 0.14 to 1.103 + 0.15 g/cm2 in group A (p < 0.001) and from 1.157 + 0.14 to 1.076 + 0.14 g/cm2 in group B (p < 0.001) and Z-score from 0.93 + 0.97 to 0.19 + 1.02, (p < 0.001) and from 1.15 + 1.29 to 0.419 + 1.28, (p < 0.001), respectively. CONCLUSIONS LL-BPD leads to similar and significant bone mass reduction 1 year postoperatively, irrespective of adequate vitamin D replacement and in the absence of secondary hyperparathyroidism.
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Affiliation(s)
- Sotirios Volonakis
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece
| | - Vasiliki Koika
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece
| | - George Tzavelas
- Department of Radiology, School of Medicine, University of Patras, 26504, Rio, Greece
| | - Marina Skopeliti
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece
| | - George Skroubis
- Department of Surgery, School of Medicine, University of Patras, 26504, Rio, Greece
| | - Fotis Kalfarentzos
- Department of Surgery, School of Medicine, University of Patras, 26504, Rio, Greece
| | - Theodore Alexandrides
- Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece.
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13
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Liao WL, Yang WC, Shaw HM, Lin CH, Wu CC, Hsu WL, Lu YC, Chao PM, Huang CK. Adherence to Nutritional Supplementation Determines Postoperative Vitamin D Status, but Not Levels of Bone Resorption Marker, in Sleeve-Gastrectomy Patients. Obes Surg 2021; 31:3707-3714. [PMID: 34033013 DOI: 10.1007/s11695-021-05484-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Taking advantage of isomeric form of vitamin E in the supplement, adherence to supplement could be evaluated by changes in circulating α- and γ-tocopherol concentrations. Accordingly, effects of supplementation on postoperative nutrition and bone metabolism were studied in terms of adherence. METHODS Thirty-eight SG patients were all prescribed a postoperative nutritional supplement containing a low dose of vitamin D (600 IU) and calcium (200 mg). Blood samples were collected prior to (M0) and 6 months after (M6) surgery and concentrations of nutrients and C-terminal telopeptide of type I collage (CTX), a marker of bone resorption, were measured. Adherence and non-adherence were stratified according to change (△, M6-M0) in serum α-tocopherol concentrations (> 0 vs. ≤ 0, respectively). RESULTS When M0 and M6 were compared, there were significant increases in serum concentrations of 25(OH)D, α-tocopherol and selenium, whereas there were reductions in parathyroid hormone, ferritin, and γ-tocopherol. At M6, the prevalence of vitamin D insufficiency (25(OH)D < 30 ng/mL) and high CTX were 72 and 26%, respectively. When comparison was made between adherence and non-adherence, only △25(OH)D concentrations, but no other nutrients nor postoperative CTX differed. Multiple linear regression demonstrated that postoperative vitamin D status was independently associated with its preoperative concentrations (β = 0.85, p < 0.001) and adherence (β = 0.52, p < 0.05). CONCLUSION SG patients' adherence to supplementation, even with a low dose of vitamin D and calcium, determined vitamin D status but not bone resorption marker concentrations, at least within 6 months after surgery.
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Affiliation(s)
- Wen-Ling Liao
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, 404, Taiwan.,Center for Personalized Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Wan-Ching Yang
- Department of Nutrition, China Medical University, Taichung, 404, Taiwan
| | - Huey-Mei Shaw
- Department of Health and Nutrition, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chi-Hsuan Lin
- Body-Science and Metabolic Disorders International (B.M.I) Medical Center, China Medical University Hospital, 2 Yu-Der Road, Taichung, 404, Taiwan
| | - Chin-Ching Wu
- Department of Public Health, China Medical University, Taichung, 404, Taiwan
| | - Wan-Lin Hsu
- Body-Science and Metabolic Disorders International (B.M.I) Medical Center, China Medical University Hospital, 2 Yu-Der Road, Taichung, 404, Taiwan
| | - Yao-Cheng Lu
- Body-Science and Metabolic Disorders International (B.M.I) Medical Center, China Medical University Hospital, 2 Yu-Der Road, Taichung, 404, Taiwan
| | - Pei-Min Chao
- Department of Nutrition, China Medical University, Taichung, 404, Taiwan.
| | - Chih-Kun Huang
- Body-Science and Metabolic Disorders International (B.M.I) Medical Center, China Medical University Hospital, 2 Yu-Der Road, Taichung, 404, Taiwan.
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14
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Short-Term Changes on Body Composition and Bone Mass After One-Anastomosis Gastric Bypass: a Prospective Observational Study. Obes Surg 2021; 30:3514-3521. [PMID: 32314255 DOI: 10.1007/s11695-020-04603-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Bariatric surgery generates a large weight loss. It is considered a successful surgery when 50% of the excess weight loss is reached. However, this measure does not include some variables that may have a direct impact on a patient's health, such as fat-free mass (FFM) or bone mass. Therefore, the aim of this study is to evaluate body composition and bone mass in patients undergoing one-anastomosis gastric bypass (OAGB). METHODS A prospective observational study was performed in patients undergoing OAGB. Body composition and bone mass were evaluated by bioelectrical impedance analysis at baseline (1 day prior to surgery), at 6 and 12 months after surgery. RESULTS A total of 94 patients (67% females and 33% males) were included in the study. The excess BMI loss at 6 and 12 months after surgery was 97.9 ± 20.1% and 110.2 ± 30.5% respectively. The FFM showed a reduction of 6.6 ± 4.8 kg (p < 0.01) 6 months after surgery and of 7.9 ± 4.9 kg (p < 0.01) at 12 months, meaning a decrease of 10.5 ± 7.3% and a 12.9 ± 6.6% respectively. The bone mass decrease was 10.1 ± 6.9% (p < 0.01) and 12.9 ± 6.5% (p < 0.01) at 12 months after OAGB. CONCLUSIONS OAGB obtains a relevant weight loss in patients with morbid obesity, mainly, due to fat mass reductions. However, this procedure also provokes FFM and bone mass decreases, especially in females, but not significantly greater than other restrictive or mixed procedures.
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15
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Cadart O, Degrandi O, Barnetche T, Mehsen-Cetre N, Monsaingeon-Henry M, Pupier E, Bosc L, Collet D, Gronnier C, Tremollieres F, Gatta-Cherifi B. Long-Term Effects of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Bone Mineral Density: a 4-Year Longitudinal Study. Obes Surg 2021; 30:3317-3325. [PMID: 32246412 DOI: 10.1007/s11695-020-04568-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Bone mineral density (BMD) declines in the initial years after bariatric surgery, but long-term skeletal effects are unclear and comparisons between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are rare. DESIGN AND METHODS An observational longitudinal study of obese patients undergoing SG or RYGB was performed. Whole-body (WB) BMD, along with BMD of the total hip (TH), femoral neck (FN), and lumbar spine (LS), was measured by dual-energy X-ray absorptiometry (DXA) before surgery and yearly thereafter for 4 years. Calciotropic hormones were also measured. RESULTS Forty-seven patients undergoing RYGB surgery and 28 patients undergoing SG were included. Four years after RYGB, BMD declined by 2.8 ± 5.8% in LS, 8.6 ± 5% in FN, 10.9 ± 6.3% in TH, and 4.2 ± 6.2% in WB, relative to baseline. For SG, BMD declined by 8.1 ± 5.5% in FN, 7.7 ± 6% in TH, 2.0 ± 7.2% in LS, and 2.5 ± 6.4% in WB after 4 years, relative to baseline. Vitamin D levels increased with supplementation in both groups. Whereas parathyroid hormone levels increased slightly in the RYGB group, they decreased modestly in the SG group (P < 0.05 in both groups). CONCLUSIONS Bone loss after 4 years was comparable between the two procedures, although RYGB was associated with a slightly greater decrease at the TH than SG. Bone health should therefore be monitored after both RYGB and SG.
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Affiliation(s)
- O Cadart
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France.,University of Bordeaux, College Santé, 33076, Bordeaux, France
| | - O Degrandi
- Digestive Surgery Department, University Hospital of Bordeaux, Pessac, France
| | - T Barnetche
- Rheumatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - N Mehsen-Cetre
- Rheumatology Department, University Hospital of Bordeaux, Bordeaux, France
| | - M Monsaingeon-Henry
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - E Pupier
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - L Bosc
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France
| | - D Collet
- Digestive Surgery Department, University Hospital of Bordeaux, Pessac, France.,University of Bordeaux, College Santé, 33076, Bordeaux, France
| | - C Gronnier
- Digestive Surgery Department, University Hospital of Bordeaux, Pessac, France.,University of Bordeaux, College Santé, 33076, Bordeaux, France
| | - F Tremollieres
- Menopause center, Hôpital Paule de Viguier, University Hospital of Toulouse, Toulouse, France
| | - Blandine Gatta-Cherifi
- Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France. .,INSERM U1215 Neurocentre Magendie, University of Bordeaux, Bordeaux, France. .,University of Bordeaux, College Santé, 33076, Bordeaux, France.
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16
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Barocrinology: The Endocrinology of Obesity from Bench to Bedside. Med Sci (Basel) 2020; 8:medsci8040051. [PMID: 33371340 PMCID: PMC7768467 DOI: 10.3390/medsci8040051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity has reached pandemic proportions. Hormonal and metabolic imbalances are the key factors that lead to obesity. South Asian populations have a unique phenotype, peculiar dietary practices, and a high prevalence of consanguinity. Moreover, many lower middle-income countries lack appropriate resources, super-specialists, and affordability to manage this complex disorder. Of late, there has been a substantial increase in both obesity and diabesity in India. Thus, many more patients are being managed by different types of bariatric procedures today than ever before. These patients have many types of endocrine and metabolic disturbances before and after bariatric surgery. Therefore, these patients should be managed by experts who have knowledge of both bariatric surgery and endocrinology. The authors propose “Barocrinology”, a novel terminology in medical literature, to comprehensively describe the field of obesity medicine highlighting the role of knowing endocrine physiology for understating its evolution, insights into its complications and appreciating the changes in the hormonal milieu following weight loss therapies including bariatric surgery. Barocrinology, coined as a portmanteau of “baro” (weight) and endocrinology, focuses upon the endocrine and metabolic domains of weight physiology and pathology. This review summarizes the key pointers of bariatric management from an endocrine perspective.
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17
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Mori C, Sheehan D, Graor CH, Petrinec A. A scoping review of the phenomenon of osteoporosis in post bariatric surgical patients. Int J Orthop Trauma Nurs 2020; 40:100835. [PMID: 33272902 DOI: 10.1016/j.ijotn.2020.100835] [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: 07/09/2020] [Revised: 11/09/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Risk factors, preventive treatment, and increased prevalence of fragility fractures in post-bariatric surgical patients have been researched, however, little is known about how patients' perspectives of osteoporosis risk determine their commitment to bone health. PURPOSE The purpose of this review was to provide an overview and appraisal of the research regarding osteoporosis in post bariatric surgical patients, as well as to identify gaps in the literature in this area. METHODS Data bases searched included OVID Medline, CINAHL, and EMBASE which included ahead of print articles that had not yet been indexed. Relevant key words were used independently and in combination: "osteoporosis," "morbid obesity," and "bariatric surgery." RESULTS A total of 24 quantitative studies and 15 qualitative studies were retrieved for this review; none of the qualitative studies examined both osteoporosis and bariatric surgery. CONCLUSION The current trend in bariatric surgical patients regarding osteoporosis is to examine the degree of bone loss based on significant influences including extent of weight loss, years since surgery, type of procedure performed, and subject selection. Patient perceptions about osteoporosis risk after bariatric surgery were rarely addressed.
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Affiliation(s)
- Candace Mori
- Nursing and Nursing Education, 210 Skyveiw Circle, Dalton, Ohio, USA.
| | - Denice Sheehan
- Kent State University College of Nursing, 10358 Hanford Lane, Twinsburg, OH, 44087, USA.
| | | | - Amy Petrinec
- Kent State University College of Nursing, 2760 Hawkesbury Boulevard, Hudson, OH, 44236, USA.
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Lindeman KG, Rushin CC, Cheney MC, Bouxsein ML, Hutter MM, Yu EW. Bone Density and Trabecular Morphology at Least 10 Years After Gastric Bypass and Gastric Banding. J Bone Miner Res 2020; 35:2132-2142. [PMID: 32663365 DOI: 10.1002/jbmr.4112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/11/2020] [Accepted: 06/07/2020] [Indexed: 12/20/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) instigates high-turnover bone loss in the initial 5 years after surgery, whereas skeletal changes after adjustable gastric banding (AGB) are less pronounced. Long-term skeletal data are scarce, and the mechanisms of bone loss remain unclear. We sought to examine bone density and microarchitecture in RYGB and AGB patients a decade after surgery and to determine whether prior published reports of bone loss represent an appropriate adaptation to new postsurgical weight. In this cross-sectional study, 25 RYGB and 25 AGB subjects who had bariatric surgery ≥10 years ago were matched 1:1 with nonsurgical controls for age, sex, and current body mass index (BMI). We obtained bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), volumetric BMD and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT), trabecular morphology by individual trabecular segmentation, and metabolic bone laboratory results. As compared with BMI-matched controls, RYGB subjects had significantly lower hip BMD, and lower total volumetric BMD at the distal radius and tibia. Substantial deficits in cortical and trabecular microarchitecture were observed in the RYGB group compared to controls, with reduced trabecular plate bone volume fraction and estimated failure load at both the radius and tibia, respectively. Bone turnover markers CTX and P1NP were 99% and 77% higher in the RYGB group than controls, respectively, with no differences in serum calcium, 25-hydroxyvitamin D, or parathyroid hormone. In contrast, the AGB group did not differ from their BMI-matched controls in any measured bone density, microarchitecture, or laboratory parameter. Thus, RYGB, but not AGB, is associated with lower than expected hip and peripheral BMD for the new weight setpoint, as well as deleterious changes in bone microarchitecture. These findings suggest that pathophysiologic processes other than mechanical unloading or secondary hyperparathyroidism contribute to bone loss after RYGB, and have important clinical implications for the long-term care of RYGB patients. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
| | - Claire C Rushin
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Mary L Bouxsein
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Matthew M Hutter
- Harvard Medical School, Boston, MA, USA.,Department of Surgery, Weight Center, Massachusetts General Hospital, Boston, MA, USA
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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19
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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:dgaa581. [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
| | - 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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20
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Abstract
PURPOSE OF REVIEW This review outlines the recent findings regarding the impact of bariatric surgery on bone. It explores potential mechanisms for skeletal changes following bariatric surgery and strategies for management. RECENT FINDINGS Bone loss following bariatric surgery is multifactorial. Probable mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Skeletal changes that occur after bariatric surgery are specific to procedure type and persist for several years post-operatively. Studies suggest that while bone loss begins early, fracture risk may be increased later in the post-operative course, particularly after Roux-en-Y gastric bypass (RYGB). Further research is needed to assess the extent to which skeletal changes following bariatric surgery result in fragility. Current management should be geared toward prevention of bone loss, correction of nutritional deficiencies, and incorporation of weight bearing exercise. Pharmacologic treatment should be considered for high-risk patients.
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Affiliation(s)
- Alexandra N Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery New York, New York, USA
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery New York, New York, USA.
- Weill Cornell Medical College, 535 East 70th Street, New York, NY, 10021, USA.
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21
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Pilone V, Tramontano S, Cutolo C, Marchese F, Pagano AM, Di Spirito F, Schiavo L. Clinical factors correlated with vitamin D deficiency in patients with obesity scheduled for bariatric surgery: A single center experience. INT J VITAM NUTR RES 2020; 90:346-352. [PMID: 32450764 DOI: 10.1024/0300-9831/a000662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We aim to assess the prevalence of vitamin D deficiency (VDD) in patients scheduled for bariatric surgery (BS), and to identify factors that might be associated with VDD. We conducted a cross-sectional observational study involving all consecutive patients scheduled for BS from 2017 to 2019. The exclusion criteria were missing data for vitamin D levels, intake of vitamin D supplements in the 3 months prior to serum vitamin D determination, and renal insufficiency. A total of 206 patients (mean age and body mass index [BMI] of 34.9 ± 10.7 years, and 44.3 ± 6.99 kg/m2, respectively) met the inclusion criteria and were enrolled for data analysis. VDD (<19.9 ng/mL), severe VDD (<10 ng/mL), and vitamin D insufficiency (20-29.9 ng/mL) were present in 68.8 %, 12.5 %, and 31.2 % of patients, respectively. A significant inverse correlation was found between vitamin D levels and initial BMI, parathyroid hormone, and homeostatic model assessment of insulin resistance (r = -0.280, p < 0.05; r = -0.407, p = 0.038; r = -0.445, p = 0.005), respectively. VDD was significantly more prevalent in patients with higher BMI [-0.413 ± 0.12, CI95 % (-0.659; -0.167), p = 0.006], whereas no significant association between hypertension [-1.005 ± 1.65, CI95 % (-4.338; 2.326), p = 0.001], and diabetes type 2 (T2D) [-0.44 ± 2.20, CI95 % (-4.876; 3.986), p = 0.841] was found. We observed significant association between female sex and levels of vitamin D [6.69 ± 2.31, CI95 % (2.06; 11.33), p = 0.006]. The present study shows that in patients scheduled for BS, VDD deficiency is common and was associated with higher BMI, and female sex.
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Affiliation(s)
- Vincenzo Pilone
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Italy.,Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | - Salvatore Tramontano
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | - Carmen Cutolo
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | - Federica Marchese
- Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
| | | | - Federica Di Spirito
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Italy
| | - Luigi Schiavo
- Department of Medicine, Surgery, and Dentistry, "Scuola Medica Salernitana", University of Salerno, Italy.,Center of Excellence of Bariatric Surgery of the Italian Society of Obesity Surgery and Metabolic Disease (SICOB), Unit of General and Emergency Surgery, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Mercato San Severino, Salerno, Italy
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22
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Muller MK, Gero D, Reitnauer D, Vetter D, Eshmuminov D, Hornemann T, Bueter M. The Impact of Roux-en-Y Gastric Bypass on Bone Remodeling Expressed by the P1NP/βCTX Ratio: a Single-Center Prospective Cohort Study. Obes Surg 2020; 29:1185-1194. [PMID: 30613933 DOI: 10.1007/s11695-018-03640-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Bariatric surgery seems to decrease bone mineral density and increase the risk of fatigue fractures. P1NP (bone formation) and βCTX (bone resorption) were recently validated as reference bone turnover markers (BTM). OBJECTIVE To assess changes in bone remodeling in severely obese patients undergoing Roux-en-Y gastric bypass (RYGB) by using a new composite biomarker, the P1NP/βCTX ratio. METHODS We prospectively collected blood samples preoperatively, at 1 month and at 1 year from 114 consecutive RYGB patients from 12/2012 to 04/2014. Repeated measures ANOVA and multiple regression were used for data analysis. Cumulative incidence of fractures was assessed in 06/2018. RESULTS The P1NP/βCTX ratio decreased significantly (P < 0.001) from baseline to 1 month and 1 year (180 ± 6.6, 110 ± 4.1, and 132 ± 5.4). The 1-year P1NP/βCTX ratio did not correlate with BMI or ΔBMI, but inversely correlated with age (r = - 0.23, P = 0.014) and with hsCRP (r = - 0.26, P = 0.009), even after adjustment for age, sex, BMI, and lifestyle, and linearly correlated with albumin (r = 0.2, P = 0.037). At baseline, none of these correlations were detectable. Serum for all time-points was available from > 94% of the patients. At a median follow-up of 4.7 years, 8 patients (7.3%) had a bone fracture, all of them traumatic. CONCLUSION Following RYGB, bone remodeling increases, with a shift toward degradation. This effect seems to be weight-loss independent and shows a correlation with age, with the level of systemic inflammation, and with nutritional state. The risk of fractures should be assessed systematically in bariatric patients and measures of prevention should be improved accordingly.
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Affiliation(s)
- Markus K Muller
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Daniela Reitnauer
- Department of Surgery, Cantonal Hospital Frauenfeld, CH-8501, Frauenfeld, Switzerland
| | - Diana Vetter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Dilmurodjon Eshmuminov
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Thorsten Hornemann
- Institute of Clinical Chemistry, University and University Hospital of Zurich, CH-8091, Zurich, Switzerland
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland.
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23
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Serum Parathyroid Hormone and 25-Hydroxyvitamin D Concentrations Before and After Biliopancreatic Diversion. Obes Surg 2019; 28:1886-1894. [PMID: 29322299 DOI: 10.1007/s11695-017-3101-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Biliopancreatic diversion with duodenal switch (BPD-DS) decreases vitamin D and calcium absorption, which may result in secondary hyperparathyroidism. This study aimed at evaluating the prevalence of vitamin D deficiency and secondary hyperparathyroidism before and after BPD-DS. METHODS A retrospective analysis of patients who had undergone BPD-DS at a tertiary bariatric center between 2003 and 2010 and for whom simultaneous measurements of serum 25-hydroxyvitamin D and parathyroid hormone were available within 5 years post-op was performed. The prevalence of vitamin D deficiency (< 20 ng/ml) and secondary hyperparathyroidism (> 65 pg/mL) at different time points was calculated. RESULTS Included were 1436 patients (mean ± SD, age 42.7 ± 10.4 years; BMI 51.5 ± 8.6 kg/m2; 69.8% women). Prevalence of vitamin D deficiency decreased up to 6-12 months after surgery (from 35.8% at baseline down to 6-9%) then rose progressively, plateauing at 15.5% after 36 months. Prevalence of hyperparathyroidism was 28.5% before surgery and rose progressively after surgery, reaching 68.6% at 5 years. Mean serum corrected calcium increased from 0 to 6 months then decreased up to 36 months. Preoperatively, the prevalence of hypocalcemia was 7.3%. It increased after 12 months, attaining 26.9% at 48 months. CONCLUSIONS Prevalence of vitamin D deficiency and secondary hyperparathyroidism is high before BPD-DS. Despite a low prevalence of vitamin D deficiency after surgery, prevalence of hyperparathyroidism increased steadily 1 year after surgery, preceded by a decrease in serum calcium. Factors explaining the high prevalence of secondary hyperparathyroidism after BPD-DS and its long-term impact on bone health should be addressed.
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24
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Casimiro I, Sam S, Brady MJ. Endocrine implications of bariatric surgery: a review on the intersection between incretins, bone, and sex hormones. Physiol Rep 2019; 7:e14111. [PMID: 31134746 PMCID: PMC6536581 DOI: 10.14814/phy2.14111] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 12/25/2022] Open
Abstract
Bariatric surgery is now the most widely used intervention for the treatment of human obesity. A large body of literature has demonstrated its efficacy in sustained weight loss and improvement in its associated comorbidities. Here, we review the effect of bariatric surgery in gut hormone physiology, bone remodeling and the reproductive axis. Rapid improvements in insulin release and sensitivity appear to be weight loss independent and occur immediately after surgery. These effects on pancreatic beta cells are mostly due to increased gut hormone secretion due to augmented nutrient delivery to the small intestine. Bone remodeling is also affected by gut hormones. Phenotypic skeletal changes observed in mice deficient in GLP-1 or GIP suggest that increased incretins may improve bone density. However, these positive effects may be counterbalanced by the association between weight loss and a reduction in bone density. Finally, studies have shown a marked improvement following bariatric surgery in infertility and PCOS in women and hypogonadism in men. Thus, the net effect on endocrine systems after bariatric surgery will likely vary on an individual basis and depend on factors such as comorbidities, peri-menopausal state, amount of weight loss, and likelihood to adhere to vitamin supplementation after surgery.
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Affiliation(s)
- Isabel Casimiro
- Section of Endocrinology, Diabetes & MetabolismUniversity of ChicagoChicagoIllinois
| | - Susan Sam
- Section of Endocrinology, Diabetes & MetabolismUniversity of ChicagoChicagoIllinois
| | - Matthew J. Brady
- Section of Endocrinology, Diabetes & MetabolismUniversity of ChicagoChicagoIllinois
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25
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Wang J, Ma J, Yu H, Zhang P, Han J, Bao Y. Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes. Surg Obes Relat Dis 2019; 15:1473-1480. [PMID: 31548003 DOI: 10.1016/j.soard.2019.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/07/2019] [Accepted: 04/06/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Bariatric surgery is an effective and therapeutic way for different metabolic diseases. It has become a focus of attention about the effects and molecular mechanisms to bone metabolism. OBJECTIVE We aim to assess the changes of bone mineral density (BMD) among Chinese obese individuals with type 2 diabetes who have undergone Roux-en-Y gastric bypass surgery (RYGB). Two ghrelin gene products, namely unacylated ghrelin (UAG) and obestatin, were evaluated the roles in this pathologic process. SETTING University-affiliated hospital, China. METHODS Thirty patients who had received RYGB were enrolled in the study. Changes in anthropometric parameters, metabolic indexes, and serum UAG and obestatin were assessed preoperatively, 6, 12, and 24 months postoperatively. BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) were identified. RESULTS RYGB resulted in statistical reductions of BMD in 3 different skeletal parts. After the first 6 months, BMD began to reduce and maintained a declining trend until 24 months postoperatively. Comparing to baseline, the maximal reduction of BMD was as high as 10.28% in total hip. The plasma concentration of UAG increased after 6 months (51.61 ± 55.21 versus 71.95 ± 64.91 pg/mL; P < .01), as well as the serum obestatin level (1.65 ± 0.88 versus 1.71 ± 0.99 ng/mL; P > .05). Although there was a slight drop of both peptides in the first year, they were still above the baseline. Notably, in the second year, UAG and obestatin rose to their peak values, respectively (91.90 ± 77.11 pg/mL and 1.74 ± 1.09 ng/mL). There was a negative correlation between UAG and BMD in all sites. Multiple linear regression analysis showed that the UAG level was the independent parameter associated with BMD at baseline (FN: β = -.407, P = .012 and TH: β = -0.396, P = .030 respectively), as well as the changes of UAG that were independently related with reduction percentage of LS BMD after 24 months (β = - .379, P = .046). CONCLUSION The reduction of BMD in obese Chinese with type 2 diabetes was observed after RYGB. The pronounced increase of serum UAG acts as an independent risk factor for the decrease of BMD.
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Affiliation(s)
- Jiajia Wang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jingyuan Ma
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Haoyong Yu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Pin Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junfeng Han
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China.
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Clinical Center for Diabetes, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
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26
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Hong CS, Bergen MA, Watters TS. Transient osteoporosis of the hip after bariatric surgery. Arthroplast Today 2019; 5:32-37. [PMID: 31020018 PMCID: PMC6475654 DOI: 10.1016/j.artd.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/27/2018] [Accepted: 10/30/2018] [Indexed: 12/04/2022] Open
Abstract
Transient osteoporosis is a rare manifestation of acute hip pain which typically resolves with weight-bearing restrictions and pain management. Our case report presents a patient who experienced atraumatic right hip pain a few weeks after an uncomplicated bariatric surgery and was diagnosed with transient osteoporosis of the hip. Her condition resolved after weeks of protected weight-bearing restrictions and nonsteroidal anti-inflammatories. Transient osteoporosis should be considered in the differential diagnosis of hip pain in patients who have undergone previous bariatric surgery.
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Affiliation(s)
- Cierra S. Hong
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael A. Bergen
- Duke University School of Medicine, Duke University Medical Center, Durham, NC, USA
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27
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Cornejo-Pareja I, Clemente-Postigo M, Tinahones FJ. Metabolic and Endocrine Consequences of Bariatric Surgery. Front Endocrinol (Lausanne) 2019; 10:626. [PMID: 31608009 PMCID: PMC6761298 DOI: 10.3389/fendo.2019.00626] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Obesity is one of the most serious worldwide epidemics of the twenty-first century according to the World Health Organization. Frequently associated with a number of comorbidities, obesity threatens and compromises individual health and quality of life. Bariatric surgery (BS) has been demonstrated to be an effective treatment to achieve not only sustained weight loss but also significant metabolic improvement that goes beyond mere weight loss. The beneficial effects of BS on metabolic traits are so widely recognized that some authors have proposed BS as metabolic surgery that could be prescribed even for moderate obesity. However, most of the BS procedures imply malabsorption and/or gastric acid reduction which lead to nutrient deficiency and, consequently, further complications could be developed in the long term. In fact, BS not only affects metabolic homeostasis but also has pronounced effects on endocrine systems other than those exclusively involved in metabolic function. The somatotropic, corticotropic, and gonadal axes as well as bone health have also been shown to be affected by the various BS procedures. Accordingly, further consequences and complications of BS in the long term in systems other than metabolic system need to be addressed in large cohorts, taking into account each bariatric procedure before making generalized recommendations for BS. In this review, current data regarding these issues are summarized, paying special attention to the somatotropic, corticotropic, gonadal axes, and bone post-operative health.
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Affiliation(s)
- Isabel Cornejo-Pareja
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
| | - Mercedes Clemente-Postigo
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- *Correspondence: Mercedes Clemente-Postigo
| | - Francisco J. Tinahones
- Unidad de Gestión Clínica Endocrinología y Nutrición, Instituto de Investigación Biomédica de Málaga—IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- Centro de Investigación Biomédica en Red (CIBER) Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Málaga, Spain
- Francisco J. Tinahones
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28
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Arhire L, Mihalache L, Padureanu S, Nita O, Gherasim A, Constantinescu D, Preda C. CHANGES IN BONE MINERAL PARAMETERS AFTER SLEEVE GASTRECTOMY: RELATIONSHIP WITH GHRELIN AND PLASMA ADIPOKINE LEVELS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2018; 14:498-504. [PMID: 31149303 PMCID: PMC6516419 DOI: 10.4183/aeb.2018.498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CONTEXT Metabolic surgery is currently the most efficient treatment for obesity, but concern is raised about the possible long-term nutritional side effects. Bone metabolism is often adversely affected after surgery, but literature data are contradictory. OBJECTIVE The aim of this study was to evaluate the evolution of bone mass parameters in the first year after laparoscopic sleeve gastrectomy in relation to anthropometric and body composition parameters and specific hormones of obesity. DESIGN We conducted a prospective study on 75 patients with obesity that underwent metabolic surgery over a course of 18 months at our center, with a follow-up period of 12 months. SUBJECTS AND METHODS All patients underwent a complex preoperative assessment and were required to return for medical follow-up at 6 and 12 months after surgery. Each visit included anthropometric parameters, DEXA and determination of specific hormonal parameters. RESULTS We noticed a significant improvement in anthropometric and body composition parameters after surgery. The value of adiponectin presented a significant increase after surgery and leptin showed a significant decrease at 6 and 12 months postoperative; ghrelin level decreased postoperative compared to preoperative, but without statistical significance. We observed no reduction in BMD after surgery, but a significant improvement in BMC at 12 months after surgery compared to preoperative. Ghrelin negatively correlated to BMD preoperative. CONCLUSIONS Despite the significant alterations in anthropometric, body composition and hormonal parameters, we found no negative effect on BMD and BMC in our study population.
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Affiliation(s)
- L.I. Arhire
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - L. Mihalache
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - S.S. Padureanu
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - O. Nita
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - A. Gherasim
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
| | - D. Constantinescu
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
| | - C. Preda
- “Gr. T. Popa” University of Medicine and Pharmacy, Faculty of Medicine, Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, Iasi, Romania
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Botella Martínez S, Petrina Jauregui E, Escalada San Martín J. Impact of bariatric surgery on bone tissue. ACTA ACUST UNITED AC 2018; 66:62-68. [PMID: 30266592 DOI: 10.1016/j.endinu.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/08/2018] [Indexed: 01/12/2023]
Abstract
The important prevalence and morbidity of obesity has generated an increase in bariatric surgery. It has a positive effect in obesity-related comorbidities. However, it's detrimental to bone health. The underline pathophysiological mechanisms are complex and heterogeneous. The knowledge of these factors may lead us to develop an adequate therapeutic intervention.
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Affiliation(s)
- Sonsoles Botella Martínez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Navarra, Pamplona, Navarra, España.
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Schafer AL, Kazakia GJ, Vittinghoff E, Stewart L, Rogers SJ, Kim TY, Carter JT, Posselt AM, Pasco C, Shoback DM, Black DM. Effects of Gastric Bypass Surgery on Bone Mass and Microarchitecture Occur Early and Particularly Impact Postmenopausal Women. J Bone Miner Res 2018; 33:975-986. [PMID: 29281126 PMCID: PMC6002877 DOI: 10.1002/jbmr.3371] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 11/09/2022]
Abstract
Roux-en-Y gastric bypass (RYGB) surgery is a highly effective treatment for obesity but negatively affects the skeleton. Studies of skeletal effects have generally examined areal bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA), but DXA may be inaccurate in the setting of marked weight loss. Further, as a result of modestly sized samples of mostly premenopausal women and very few men, effects of RYGB by sex and menopausal status are unknown. We prospectively studied the effects of RYGB on skeletal health, including axial and appendicular volumetric BMD and appendicular bone microarchitecture and estimated strength. Obese adults (N = 48; 27 premenopausal and 11 postmenopausal women, 10 men) with mean ± SD body mass index (BMI) 44 ± 7 kg/m2 were assessed before and 6 and 12 months after RYGB. Participants underwent spine and hip DXA, spine QCT, radius and tibia HR-pQCT, and laboratory evaluation. Mean 12-month weight loss was 37 kg (30% of preoperative weight). Overall median 12-month increase in serum collagen type I C-telopeptide (CTx) was 278% (p < 0.0001), with greater increases in postmenopausal than premenopausal women (p = 0.049). Femoral neck BMD by DXA decreased by mean 5.0% and 8.0% over 6 and 12 months (p < 0.0001). Spinal BMD by QCT decreased by mean 6.6% and 8.1% (p < 0.0001); declines were larger among postmenopausal than premenopausal women (11.6% versus 6.0% at 12 months, p = 0.02). Radial and tibial BMD and estimated strength by HR-pQCT declined. At the tibia, detrimental changes in trabecular microarchitecture were apparent at 6 and 12 months. Cortical porosity increased at the radius and tibia, with more dramatic 12-month increases among postmenopausal than premenopausal women or men at the tibia (51.4% versus 18.3% versus 3.0%, p < 0.01 between groups). In conclusion, detrimental effects of RYGB on axial and appendicular bone mass and microarchitecture are detectable as early as 6 months postoperatively. Postmenopausal women are at highest risk for skeletal consequences and may warrant targeted screening or interventions. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Anne L Schafer
- Department of Medicine, University of California, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Galateia J Kazakia
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Lygia Stewart
- Department of Surgery, University of California, San Francisco, CA, USA.,Surgical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Stanley J Rogers
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California, San Francisco, CA, USA.,Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Jonathan T Carter
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Andrew M Posselt
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Courtney Pasco
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Dolores M Shoback
- Department of Medicine, University of California, San Francisco, CA, USA.,Medical Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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Zhang Q, Chen Y, Li J, Chen D, Cheng Z, Xu S, Huang Y, Wang Q. A meta-analysis of the effects of bariatric surgery on fracture risk. Obes Rev 2018; 19:728-736. [PMID: 29334691 DOI: 10.1111/obr.12665] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 02/05/2023]
Abstract
Bariatric surgery effectively treats morbid obesity. However, the negative effect of this surgery on the bone is concerning. The aim of this meta-analysis was to investigate the fracture risk associated with bariatric surgery in morbidly obese subjects. Relevant studies published from database inception to September 2017 were identified in PubMed, Embase and the Cochrane Library. The Newcastle-Ottawa Scale was used to evaluate the quality of the observational studies, and the Jadad score evaluated randomized controlled trials. Among the 1003 studies initially identified, five observational trials and one randomized controlled trial were eligible for inclusion. All studies included in the meta-analysis were considered high quality. Risk for any type of fracture was higher in the surgical group than in the non-surgical group (risk ratio [RR] 1.29, 95% confidence interval [CI] 1.18-1.42). After surgery, the fracture risk in non-vertebral sites was significantly increased, especially in the upper limbs (RR 1.42, 95% CI 1.08-1.87; and RR 1.68, 95% CI 1.15-2.45). Compared with those with restrictive procedures, subjects who underwent mixed restrictive and malabsorptive procedures tended to have an increased fracture risk (RR 1.54, 95% CI 0.96-2.46). To conclude, bariatric surgery is associated with an increased risk of total and non-vertebral fractures, especially in the upper limbs.
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Affiliation(s)
- Q Zhang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Chen
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - J Li
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - D Chen
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Z Cheng
- Department of Gastrointestinal Surgery, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - S Xu
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Y Huang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
| | - Q Wang
- Department of Endocrinology and Metabolism, Sichuan University West China Hospital, Chengdu, Sichuan, China
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Unraveling the compromised biomechanical performance of type 2 diabetes- and Roux-en-Y gastric bypass bone by linking mechanical-structural and physico-chemical properties. Sci Rep 2018; 8:5881. [PMID: 29651097 PMCID: PMC5897570 DOI: 10.1038/s41598-018-24229-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 03/06/2018] [Indexed: 02/01/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a metabolic disorder associated with obesity and hyperglycemia. Roux-en-Y gastric bypass (RYGB) surgery is a common treatment for severely obese patients and T2DM. Both RYGB and T2DM are linked to increased skeletal fragility, though the exact mechanisms are poorly understood. Our aim was to characterize the structural, mechanical and compositional properties of bones from diet-induced obese and RYGB-treated obese (bypass) mice to elucidate which the exact factors are contributing to the increased skeletal fragility. To achieve this, a combinatory approach including microfocus X-ray computed tomography, 3-point bending, finite element modeling and Raman spectroscopy, was used. Compared to aged-matched lean controls, the obese mice displayed decreased cortical thickness, trabecular bone loss, decreased stiffness and increased Young’s modulus. For the bypass mice, these alterations were even more pronounced, and additionally they showed low mineral-to-matrix ratio in the cortical endosteal area. Accumulation of the advanced glycation end-product (AGE) pentosidine was found in the cortex of obese and bypass groups and this accumulation was correlated with an increased Young’s modulus. In conclusion, we found that the increased fracture risk in T2DM- and post-RYGB bones is mainly driven by accumulation of AGEs and macro-structural alterations, generating biomechanical dysfunctionality.
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Affiliation(s)
- Naga Yalla
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University, St. Louis, MO.
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Marcil G, Bourget-Murray J, Shinde S, Switzer N, Debru E, Church N, Mitchell P, Reso A, Gill RS. The incidence of fractures following bariatric surgery: A systematic review. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chakhtoura M, Rahme M, El-Hajj Fuleihan G. Vitamin D Metabolism in Bariatric Surgery. Endocrinol Metab Clin North Am 2017; 46:947-982. [PMID: 29080645 DOI: 10.1016/j.ecl.2017.07.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hypovitaminosis D is common in obese patients and persists after roux-en-Y gastric bypass and sleeve gastrectomy. Several societies recommend screening for vitamin D deficiency before bariatric surgery, and replacement doses of 3000 IU/d and up to 50,000 IU 1 to 3 times per week, in case of deficiency, with periodic monitoring. These regimens are mostly based on expert opinion. Large trials are needed to assess the vitamin D dose response, by type of bariatric surgery, and evaluate the effect on surrogate markers of skeletal outcomes. Such data are essential to derive desirable vitamin D levels in this population.
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Affiliation(s)
- Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon.
| | - Maya Rahme
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - Ghada El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
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Crawford MR, Pham N, Khan L, Bena JF, Schauer PR, Kashyap SR. INCREASED BONE TURNOVER IN TYPE 2 DIABETES PATIENTS RANDOMIZED TO BARIATRIC SURGERY VERSUS MEDICAL THERAPY AT 5 YEARS. Endocr Pract 2017; 24:256-264. [PMID: 29144812 DOI: 10.4158/ep-2017-0072] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of our study was to determine the 5-year outcomes of bariatric surgery versus intensive medical therapy on bone turnover in patients with type 2 diabetes mellitus (T2DM) from the STAMPEDE trial. METHODS This was an ancillary investigation of a 5-year randomized control trial at a single tertiary care center involving 95 patients aged 48.5 ± 8 years with obesity (body mass index [BMI], 36.5 ± 3.6 kg/m2) and uncontrolled T2DM (glycated hemoglobin 9.3 ± 1.6% [78 mmol/mol]). Patients were randomized to intensive medical therapy (IMT; n = 25), Roux-en-Y gastric bypass (RYGB; n = 37), or sleeve gastrectomy (SG; n = 33) for diabetes treatment. Bone formation marker osteocalcin (OC), bone resorption marker serum C-telopeptide of type 1 collagen (CTX), and intact parathyroid hormone (PTH) were assessed at baseline and 5 years postintervention. Analysis with key clinical parameters and outcomes (i.e., age, menopausal status, gender, weight loss) was performed. RESULTS Percent change in CTX at 5 years increased in both surgical groups, by 137 ± 108% in RYGB ( P<.001) and 61.1 ± 90% in SG ( P<.001) compared to 29.8 ± 93% in IMT ( P = .12). OC also increased from baseline in the surgical cohorts, by 138 ± 19% in RYGB ( P<.001) and 71 ± 69% in SG ( P<.001) compared to 43.8 ± 121.1% in IMT ( P = .83). Increases in both CTX and OC correlated linearly with increases in PTH levels in RYGB patients ( P<.001). Increase in CTX correlated with decreased BMI in SG patients ( P = .039). CONCLUSION In patients with T2DM, bone turnover remains chronically elevated at 5 years following RYGB, and to a lesser extent in SG patients. ABBREVIATIONS BMI = body mass index; BTM = bone turnover marker; CTX = C-telopeptide of type 1 collagen; HbA1c = glycated hemoglobin; IMT = intensive medical therapy; OC = osteocalcin; PPI = proton-pump inhibitor; PTH = parathyroid hormone; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; T2DM = type 2 diabetes mellitus; TZD = thiazolidinedione.
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Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B. Bariatric surgery and long-term nutritional issues. World J Diabetes 2017; 8:464-474. [PMID: 29204255 PMCID: PMC5700383 DOI: 10.4239/wjd.v8.i11.464] [Citation(s) in RCA: 193] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/11/2017] [Accepted: 09/04/2017] [Indexed: 02/05/2023] Open
Abstract
Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related co-morbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multi-vitamins and mineral supplements according to the patient's needs.
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Affiliation(s)
- Roberta Lupoli
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Erminia Lembo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Gennaro Saldalamacchia
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Claudia Kesia Avola
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
| | - Luigi Angrisani
- Department of Public Health, Federico II University, 80131 Naples, Italy
| | - Brunella Capaldo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
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Abstract
BACKGROUND Bariatric patients regularly present with insufficient vitamin D status before and after surgery, which requires substantial supplementation to treat. This review aims to assess the effect of sleeve gastrectomy on vitamin D status and the effectiveness of vitamin D supplementation. METHODS This review was conducted in accordance with the Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies. RESULTS The current guidelines recommend initial vitamin D supplementation of at least 3000 IU/day post-operatively, with no need for follow-up testing after sleeve gastrectomy. Only one study has trialled a dose in line with the recommendations for this patient group. They found that it was effective in improving VitD status. CONCLUSIONS On-going monitoring of vitamin D status is necessary, as the recommended level is not often reached.
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Schafer AL. Vitamin D and intestinal calcium transport after bariatric surgery. J Steroid Biochem Mol Biol 2017; 173:202-210. [PMID: 28027914 PMCID: PMC5483209 DOI: 10.1016/j.jsbmb.2016.12.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/21/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022]
Abstract
Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients.
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Affiliation(s)
- Anne L Schafer
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, United States; Departments of Medicine and of Epidemiology & Biostatistics, University of California, San Francisco, United States.
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Cook FJ, Khanna I, Giordano J, Matarese L, Hudson S. LONG-TERM BONE HEALTH AFTER ROUX-EN-Y GASTRIC BYPASS: A PILOT STUDY. Endocr Pract 2017; 23:1077-1084. [PMID: 28683234 DOI: 10.4158/ep171823.or] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This cross-sectional study was undertaken to assess metabolic bone disease by examining bone mineral density (BMD), fracture prevalence, and nutritional factors pertinent to bone in a cohort >9 years post-Rouxen-Y gastric bypass (RYGB). METHODS Fifty-one subjects 9.4 to 36.0 years (mean 17.0 ± 8.1) post-RYGB provided a focused history. Dietary calcium and protein were assessed. Dual-energy X-ray absorptiometry (DXA) BMD at the spine, hip, and radius and routine serum chemistries, magnesium, phosphorus, parathyroid hormone, vitamin D, vitamin K, and micronutrients were analyzed. Sixteen subjects provided 24-hour urine for measurement of calcium. RESULTS The mean maximum weight loss was 70.3 ± 20 kg (47.4 ± 8.9%), and mean net weight loss was 46.9 ± 23.1 kg (31.2 ± 12.5%). The prevalence rates of fracture, secondary hyperparathyroidism, and vitamin D deficiency were 15.7%, 37%, and 39%, respectively. BMD was in the osteoporotic range in 27.5%. The mean calcium:creatinine clearance ratio was 0.0124 ± 0.0131. Median intakes of dietary calcium, total calcium, protein, and vitamin D were 582.5 mg, 947.5 mg, 50.2 g, and 1,000 IU, respectively. Mean Z-scores at all sites were <0 (P<.01). A negative correlation (P<.05) was noted between distal radius Z-score and net change in BMI. Net change in BMI was greater for those with osteoporosis than those without. (P<.05) Conclusion: Many years after RYGB, BMD remains lower than expected compared to an age-, sex-, race-, and weight-matched reference population and is correlated with the amount of weight lost. Deficiencies of Vitamin D and calcium are prevalent. ABBREVIATIONS BMD = bone mineral density BMI = body mass index Ca:Cr = calcium:creatinine DXA = dual-energy X-ray absorptiometry PTH = parathyroid hormone RYGB = Roux-en-Y gastric bypass UD = ultradistal WHO = World Health Organization.
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Yu EW, Lee MP, Landon JE, Lindeman KG, Kim SC. Fracture Risk After Bariatric Surgery: Roux-en-Y Gastric Bypass Versus Adjustable Gastric Banding. J Bone Miner Res 2017; 32:1229-1236. [PMID: 28251687 PMCID: PMC5466471 DOI: 10.1002/jbmr.3101] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 02/09/2017] [Accepted: 02/10/2017] [Indexed: 01/06/2023]
Abstract
The long-term consequences of bariatric surgery on fracture risk are unclear but are likely to vary by procedure type. In physiologic studies, Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) have differential effects on rates of bone loss. Therefore, our objective was to compare fracture risk in obese adults after RYGB and AGB procedures. Using claims data from a US commercial health plan, we analyzed rates of nonvertebral fractures within a propensity score-matched cohort (n = 15,032) of morbidly obese adults who received either RYGB or AGB surgery between 2005 and 2013. A total of 281 nonvertebral fractures occurred during a mean follow-up time of 2.3 ± 1.9 years. RYGB patients had an increased risk of nonvertebral fracture (hazard ratio [HR] = 1.43, 95% confidence interval [CI] 1.13-1.81) compared with AGB patients. In fracture site-specific analyses, RYGB patients had increased risk of fracture at the hip (HR = 1.54, 95% CI 1.03-2.30) and wrist (HR = 1.45, 95% CI 1.01-2.07). Nonvertebral fracture risk associated with RYGB manifested >2 years after surgery and increased in subsequent years, with the highest risk in the fifth year after surgery (HR = 3.91, 95% CI 1.58-9.64). In summary, RYGB is associated with a 43% increased risk of nonvertebral fracture compared with AGB, with risk increasing >2 years after surgery. Fracture risk should be considered in risk/benefit discussions of bariatric surgery, particularly among patients with high baseline risk of osteoporosis who are deciding between RYGB and AGB procedures. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Moa P. Lee
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Joan E. Landon
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
| | - Katherine G. Lindeman
- Endocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Seoyoung C. Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Immunology and Allergy; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA, USA
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Ghazi AA, Amirbaigloo A. Hypocalcemia and osteomalacia after bariatric surgery. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2017; 14:227-229. [PMID: 29263738 PMCID: PMC5726214 DOI: 10.11138/ccmbm/2017.14.1.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Obesity has become a major health problem not only in industrialized societies but also in developing countries. Multiple studies have shown that bariatric surgery has been effective in reducing substantial amount of weight and also the comorbidities and is being performed more frequently as an established treatment. Due to anatomical and physiological alterations after surgery that impairs absorption of vitamin D and calcium, two fundamental factors in bone formation, their intestinal absorption is highly compromised. CASE REPORT We present a 48-year-old woman who was visited in emergency room for generalized bone pain, perioral paresthesia and carpopedal spasm. She had undergone bariatric surgery 15 years ago. Chvostek's sign and Trousseau's sign were positive. Examination of thoracic ribs elicited severe pain on palpation. Laboratory evaluation revealed: Ca = 6.1 mg/dL, P= 2.1 mg/dL, alkaline phosphatase = 432 (160-303), PTH=541 pg/mL, and 25(OH)D3= 3 ng/mL. Whole body bone scan showed increased uptake in the anterior arc of left 6th rib, posterior arc of left 6th and 12th ribs with increased uptake of costochondral joints. CONCLUSION Our case highlights the possible consequences that bariatric surgery may have on bone and mineral health and the need for regular and proactive follow-up of the patients.
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Affiliation(s)
- Ali A. Ghazi
- Professor of Endocrinology, Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Teheran, Iran
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Barro V, Nuñez JH, Gargallo-Margarit A, Sallent A, Aguilar M, Hernandez A. Bilateral insufficiency hip fractures after bariatric surgery. Osteoporos Int 2017; 28:1495-1498. [PMID: 28012018 DOI: 10.1007/s00198-016-3889-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
Bariatric surgery is one of the most common surgeries within developed countries due to the increase in morbid obesity that has been observed in the past decades. The short-term alterations in the metabolism of calcium and vitamin D are well known after these procedures; however, the clinical and biochemical consequences may not be detected for years or even remain undiagnosed. We present the first case of bilateral insufficiency hip fracture after years of bariatric surgery. Although this is a long-term and rare complication, with the high number of gastric bypass performed in the past years, the number of these cases could increase with time. Moreover, it is important as an undiagnosed hip fracture can cause a displacement that could need an arthroplasty, with all the complications that entails. For that reason, this long-term complication highlights the need to reevaluate the optimal follow-up of these patients and the importance to continue monitoring metabolic bone diseases in the prevention of insufficiency fractures.
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Affiliation(s)
- V Barro
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - J H Nuñez
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - A Gargallo-Margarit
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - A Sallent
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - M Aguilar
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - A Hernandez
- Hip Unit. Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Harper C, Pattinson AL, Fernando HA, Zibellini J, Seimon RV, Sainsbury A. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity. Horm Mol Biol Clin Investig 2017; 28:133-149. [PMID: 27665425 DOI: 10.1515/hmbci-2016-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. MATERIALS AND METHODS This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. RESULTS AND CONCLUSIONS All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) - but not BMD - and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).
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Bredella MA, Greenblatt LB, Eajazi A, Torriani M, Yu EW. Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue. Bone 2017; 95:85-90. [PMID: 27871812 PMCID: PMC5222731 DOI: 10.1016/j.bone.2016.11.014] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/19/2016] [Accepted: 11/14/2016] [Indexed: 02/07/2023]
Abstract
Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1±5.1kg/m2) prior to and 12months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-L2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p<0.04) although the change in femoral vBMD by QCT was not significantly different between groups (p>0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (p<0.04), suggesting that subjects with less weight and VAT loss had higher MAT. In conclusion, RYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with greater decline of aBMD at the total hip and femoral neck compared to SG. MAT content increased after SG and this was associated with lower weight and VAT loss.
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Affiliation(s)
- Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Logan B Greenblatt
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alireza Eajazi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Elaine W Yu
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
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Rousseau C, Jean S, Gamache P, Lebel S, Mac-Way F, Biertho L, Michou L, Gagnon C. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study. BMJ 2016; 354:i3794. [PMID: 27814663 PMCID: PMC4964103 DOI: 10.1136/bmj.i3794] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate whether bariatric surgery increases the risk of fracture. DESIGN Retrospective nested case-control study. SETTING Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. PARTICIPANTS 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. MAIN OUTCOME MEASURES Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. RESULTS Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for biliopancreatic diversion. CONCLUSIONS Patients undergoing bariatric surgery were more likely to have fractures than were obese or non-obese controls, and this risk remained higher after surgery. Fracture risk was site specific, changing from a pattern associated with obesity to a pattern typical of osteoporosis after surgery. Only biliopancreatic diversion was clearly associated with fracture risk; however, results for Roux-en-Y gastric bypass and sleeve gastrectomy remain inconclusive. Fracture risk assessment and management should be part of bariatric care.
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Affiliation(s)
- Catherine Rousseau
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Sonia Jean
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
- Institut national de santé publique du Québec, Quebec City, Canada, G1V 5B3
| | - Philippe Gamache
- Institut national de santé publique du Québec, Quebec City, Canada, G1V 5B3
| | - Stéfane Lebel
- Quebec Heart and Lung Institute - Laval University, Quebec City, Canada, G1V 4G5
| | - Fabrice Mac-Way
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Laurent Biertho
- Quebec Heart and Lung Institute - Laval University, Quebec City, Canada, G1V 4G5
| | - Laëtitia Michou
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU de Québec Research Centre, Quebec City, Canada, G1V 4G2
- Department of Medicine, Laval University, Quebec City, Canada, G1V 0A6
- Institute of Nutrition and Functional Foods, Quebec City, Canada, G1V 0A6
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Lu CW, Chang YK, Chang HH, Kuo CS, Huang CT, Hsu CC, Huang KC. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study. Medicine (Baltimore) 2015; 94:e2087. [PMID: 26632892 PMCID: PMC4674195 DOI: 10.1097/md.0000000000002087] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric surgery on the risk of fractures.
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Affiliation(s)
- Chia-Wen Lu
- From the Department of Family Medicine, National Taiwan University Hospital, Taipei (C-WL, H-HC, C-SK, K-CH); Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County (Y-KC, C-TH, C-CH, K-CH); Department of Family Medicine, College of Medicine, National Taiwan University, Taipei (K-CH); Department of Health Services Administration, China Medical University, Taichung City (C-CH); and Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan (C-CH)
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Heras Benito M, Gallardo Martin AI, Martín Varas CR, Fernández-Reyes Luis MJ. [Chronic potassium depletion in patient with biliopancreatic diversion]. HIPERTENSION Y RIESGO VASCULAR 2015; 33:36-8. [PMID: 26531298 DOI: 10.1016/j.hipert.2015.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- M Heras Benito
- Servicio de Nefrología. Hospital General de Segovia, Segovia, España.
| | | | - C R Martín Varas
- Servicio de Nefrología. Hospital General de Segovia, Segovia, España
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Yu EW, Bouxsein ML, Putman MS, Monis EL, Roy AE, Pratt JSA, Butsch WS, Finkelstein JS. Two-year changes in bone density after Roux-en-Y gastric bypass surgery. J Clin Endocrinol Metab 2015; 100:1452-9. [PMID: 25646793 PMCID: PMC4399296 DOI: 10.1210/jc.2014-4341] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Bariatric surgery is increasingly popular but may lead to metabolic bone disease. OBJECTIVE The objective was to determine the rate of bone loss in the 24 months after Roux-en-Y gastric bypass. DESIGN AND SETTING This was a prospective cohort study conducted at an academic medical center. PARTICIPANTS The participants were adults with severe obesity, including 30 adults undergoing gastric bypass and 20 nonsurgical controls. OUTCOMES We measured bone mineral density (BMD) at the lumbar spine and proximal femur by quantitative computed tomography (QCT) and dual-energy x-ray absorptiometry at 0, 12, and 24 months. BMD and bone microarchitecture were also assessed by high-resolution peripheral QCT, and estimated bone strength was calculated using microfinite element analysis. RESULTS Weight loss plateaued 6 months after gastric bypass but remained greater than controls at 24 months (-37 ± 3 vs -5 ± 3 kg [ mean ± SEM]; P < .001). At 24 months, BMD was 5-7% lower at the spine and 6-10% lower at the hip in subjects who underwent gastric bypass compared with nonsurgical controls, as assessed by QCT and dual-energy x-ray absorptiometry (P < .001 for all). Despite significant bone loss, average T-scores remained in the normal range 24 months after gastric bypass. Cortical and trabecular BMD and microarchitecture at the distal radius and tibia deteriorated in the gastric bypass group throughout the 24 months, such that estimated bone strength was 9% lower than controls. The decline in BMD persisted beyond the first year, with rates of bone loss exceeding controls throughout the second year at all skeletal sites. Mean serum calcium, 25(OH)-vitamin D, and PTH were maintained within the normal range in both groups. CONCLUSIONS Substantial bone loss occurs throughout the 24 months after gastric bypass despite weight stability in the second year. Although the benefits of gastric bypass surgery are well established, the potential for adverse effects on skeletal integrity remains an important concern.
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Affiliation(s)
- Elaine W Yu
- Endocrine Unit (E.W.Y., M.L.B., M.S.P., E.L.M., A.E.R., J.S.F.), and Weight Center (J.S.A.P., W.S.B.), Massachusetts General Hospital, Boston, Massachusetts 02114
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Baptista LS, Silva KR, Borojevic R. Obesity and weight loss could alter the properties of adipose stem cells? World J Stem Cells 2015; 7:165-173. [PMID: 25621116 PMCID: PMC4300927 DOI: 10.4252/wjsc.v7.i1.165] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/22/2014] [Accepted: 10/27/2014] [Indexed: 02/06/2023] Open
Abstract
The discovery that adipose tissue represents an interesting source of multipotent stem cells has led to many studies exploring the clinical potential of these cells in cell-based therapies. Recent advances in understanding the secretory capacity of adipose tissue and the role of adipokines in the development of obesity and associated disorders have added a new dimension to the study of adipose tissue biology in normal and diseased states. Subcutaneous adipose tissue forms the interface between the clinical application of regenerative medicine and the establishment of the pathological condition of obesity. These two facets of adipose tissue should be understood as potentially related phenomena. Because of the functional characteristics of adipose stem cells, these cells represent a fundamental tool for understanding how these two facets are interconnected and could be important for therapeutic applications. In fact, adipose tissue stem cells have multiple functions in obesity related to adipogenic, angiogenic and secretory capacities. In addition, we have also previously described a predominance of larger blood vessels and an adipogenic memory in the subcutaneous adipose tissue after massive weight loss subsequent to bariatric surgery (ex-obese patients). Understanding the reversibility of the behavior of adipose stem cells in obeses and in weight loss is relevant to both physiological studies and the potential use of these cells in regenerative medicine.
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