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Gómez-Bruton A, Irún P, Matute-Llorente A, Lozano-Berges G, Moradell A, Ara-Gimeno S, Subias-Perie J, Sánchez-Luengo M, Hijos-Mallada G, García-Mateo S, Arechavaleta S, Palacios Fanlo MJ, Lanas A, Casajús JA. Effects of whole-body vibration on body composition, microbiota, cardiometabolic markers, physical fitness, and quality of life after bariatric surgery: protocol for a randomized controlled trial. Trials 2024; 25:413. [PMID: 38926901 PMCID: PMC11210142 DOI: 10.1186/s13063-024-08221-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Morbid obesity is a complex chronic condition characterized by a body mass index of 40 kg/m2 or higher. The incidence of the condition is on the rise in developed countries, and bariatric surgery has been proposed as a potential solution to address this trend. Nonetheless, bariatric surgery may also result in adverse effects, including a reduction in bone mineral density (BMD) and muscle mass, as well as an increased risk of fractures. The present study aims to elucidate the effects of bariatric surgery and whole-body vibration (WBV) training on body composition, microbiota, physical fitness, quality of life, and cardiometabolic markers. METHODS Twenty-eight participants (14 females), aged 18 to 50 years, will undergo sleeve gastrectomy surgery. They will be randomly allocated into a control group or a WBV training group. The WBV group will train three times per week with increasing intensities and duration ranging from 30 to 45 min over the 4-month training period. Measurements of body composition (dual-energy X-ray absorptiometry and peripheral quantitative computed tomography), physical fitness (muscular strength, agility, cardiorespiratory fitness, and balance), gait biomechanics, cardiometabolic markers, gut microbiota, quality of life, and physical activity levels will be collected at four different time points: (1) prior to the surgery, (2) 45 days post-surgery, (3) 6 months post-surgery, and (4) 18 months post-surgery. DISCUSSION Both groups are expected to experience improvements in most of the aforementioned variables. Nonetheless, we expect the WBV group to show larger improvements proving that the training is effective and safe. TRIAL REGISTRATION Clinicaltrials.gov NCT05695599. Registered on January 25, 2023.
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Affiliation(s)
- Alejandro Gómez-Bruton
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain.
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de La Salud y del Deporte, Universidad de Zaragoza, Huesca, Spain.
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - Pilar Irún
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - Angel Matute-Llorente
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de La Salud y del Deporte, Universidad de Zaragoza, Huesca, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Gabriel Lozano-Berges
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de La Salud y del Deporte, Universidad de Zaragoza, Huesca, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Moradell
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Ciencias de La Salud y del Deporte, Universidad de Zaragoza, Huesca, Spain
| | - Susana Ara-Gimeno
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
| | - Jorge Subias-Perie
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
- Facultad de Ciencias de La Salud, Universidad de Zaragoza, Zaragoza, Spain
| | - Marta Sánchez-Luengo
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Service of Digestive Diseases, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Gonzalo Hijos-Mallada
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Service of Digestive Diseases, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Sandra García-Mateo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Service of Digestive Diseases, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Samantha Arechavaleta
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | - María José Palacios Fanlo
- Servicio de Cirugía General y Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Angel Lanas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Service of Digestive Diseases, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
- Departamento de Medicina, Psiquiatría y Dermatología, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
| | - Jose A Casajús
- EXER-GENUD (EXERCISE-Growth, Exercise, NUtrition and Development) Grupo de Investigación, Universidad de Zaragoza, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de La Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Fisiatría y Enfermería, Facultad de Medicina, Universidad de Zaragoza, Zaragoza, Spain
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2
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Wu KC, Wu PH, Kazakia G, Patel S, Black DM, Lang TF, Kim TY, King NJ, Hoffman TJ, Chang H, Linfield G, Palilla S, Rogers SJ, Carter JT, Posselt AM, Schafer AL. Skeletal effects of sleeve gastrectomy, by sex and menopausal status and in comparison to Roux-en-Y gastric bypass surgery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.06.25.24309368. [PMID: 38978665 PMCID: PMC11230331 DOI: 10.1101/2024.06.25.24309368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Context Roux-en-Y gastric bypass (RYGB) has deleterious effects on bone mass, microarchitecture, and strength. Data are lacking on the skeletal effects of sleeve gastrectomy (SG), now the most commonly performed bariatric surgical procedure. Objective We examined changes in bone turnover, areal and volumetric bone mineral density (aBMD, vBMD), and appendicular bone microarchitecture and estimated strength after SG. We compared the results to those previously reported after RYGB, hypothesizing lesser effects after SG than RYGB. Design Setting Participants Prospective observational cohort study of 54 adults with obesity undergoing SG at an academic center. Main Outcome Measures Skeletal characterization with biochemical markers of bone turnover, dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) was performed preoperatively and 6- and 12-months postoperatively. Results Over 12 months, mean percentage weight loss was 28.8%. Bone turnover marker levels increased, and total hip aBMD decreased -8.0% (95% CI -9.1%, -6.7%, p<0.01). Spinal aBMD and vBMD declines were larger in postmenopausal women than men. Tibial and radial trabecular and cortical microstructure worsened, as did tibial estimated strength, particularly in postmenopausal women. When compared to data from a RYGB cohort with identical design and measurements, some SG biochemical, vBMD, and radial microstructural parameters were smaller, while other changes were not. Conclusions Bone mass, microstructure, and strength decrease after SG. Some skeletal parameters change less after SG than after RYGB, while for others, we find no evidence for smaller effects after SG. Postmenopausal women may be at highest risk of skeletal consequences after SG.
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Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Po-Hung Wu
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Galateia Kazakia
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Thomas F Lang
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Thomas J Hoffman
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Institute for Human Genetics, University of California San Francisco, San Francisco, CA, USA
| | - Hanling Chang
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Gaia Linfield
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sarah Palilla
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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3
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Chen R, Armamento-Villareal R. Obesity and Skeletal Fragility. J Clin Endocrinol Metab 2024; 109:e466-e477. [PMID: 37440585 PMCID: PMC10795939 DOI: 10.1210/clinem/dgad415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Skeletal fracture has recently emerged as a complication of obesity. Given the normal or better than normal bone mineral density (BMD), the skeletal fragility of these patients appears to be a problem of bone quality rather than quantity. Type 2 diabetes mellitus (T2DM), the incidence of which increases with increasing body mass index, is also associated with an increased risk for fractures despite a normal or high BMD. With the additional bone pathology from diabetes itself, patients with both obesity and T2DM could have a worse skeletal profile. Clinically, however, there are no available methods for identifying those who are at higher risk for fractures or preventing fractures in this subgroup of patients. Weight loss, which is the cornerstone in the management of obesity (with or without T2DM), is also associated with an increased risk of bone loss. This review of the literature will focus on the skeletal manifestations associated with obesity, its interrelationship with the bone defects associated with T2DM, and the available approach to the bone health of patients suffering from obesity.
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Affiliation(s)
- Rui Chen
- Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes and Metabolism at Baylor College of Medicine, Houston, TX 77030, USA
- Department of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
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4
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Stapleton JR, Ard JD, Beavers DP, Cogdill LS, Fernandez AZ, Howard MJ, Justice JN, Lynch SD, Newman JJ, Weaver AA, Beavers KM. Strategies to reduce the onset of sleeve gastrectomy associated bone loss (STRONG BONES): Trial design and methods. Contemp Clin Trials Commun 2023; 34:101181. [PMID: 37456507 PMCID: PMC10344650 DOI: 10.1016/j.conctc.2023.101181] [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: 03/07/2023] [Revised: 06/05/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Despite recognized improvements in obesity-related comorbidities, mounting evidence implicates surgical weight loss in the onset of skeletal fragility. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure and is associated with 3-7% axial bone loss in the year following surgery. Bisphosphonates are FDA-approved medications for the prevention and treatment of age-related bone loss and may represent a strategy to reduce bone loss following SG surgery. Methods The Strategies to Reduce the Onset of Sleeve Gastrectomy Associated Bone Loss (STRONG BONES) trial (NCT04922333) is designed to definitively test whether monthly administration of the bisphosphonate, risedronate, for six months can effectively counter SG-associated bone loss. Approximately 120 middle-aged and older (≥40 years) SG patients will be randomized to six months of risedronate or placebo treatment, with skeletal outcomes assessed at baseline, six, and 12-months post-surgery. The primary outcome of the trial is 12-month change in total hip areal bone mineral density (aBMD), measured by dual energy x-ray absorptiometry (DXA). This will be complemented by DXA-acquired aBMD assessment at other skeletal sites and quantitative computed tomography (QCT) derived changes in bone quality. Change in muscle mass and function will also be assessed, as well as biomarkers of bone health, turnover, and crosstalk, providing mechanistic insight into intervention-related changes to the bone-muscle unit. Discussion Results from the STRONG BONES trial have the potential to influence current clinical practice by determining the ability of bisphosphonate use to mitigate bone loss and concomitant fracture risk in middle-aged and older SG patients.
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Affiliation(s)
- Joshua R. Stapleton
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamy D. Ard
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel P. Beavers
- Department of Statistical Sciences, Wake Forest University, Winston-Salem, NC, USA
| | - Lori S. Cogdill
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Marjorie J. Howard
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jamie N. Justice
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - S. Delanie Lynch
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Jovita J. Newman
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
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5
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Li Z, Qiu K, Zhao J, Granger K, Yu H, Lewis AG, Myronovych A, Toure MH, Hatsell SJ, Economides AN, Seeley RJ, MacDougald OA. Antibodies to sclerostin or G-CSF receptor partially eliminate bone or marrow adipocyte loss, respectively, following vertical sleeve gastrectomy. Bone 2023; 169:116682. [PMID: 36709915 PMCID: PMC10513354 DOI: 10.1016/j.bone.2023.116682] [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: 11/29/2022] [Revised: 01/10/2023] [Accepted: 01/21/2023] [Indexed: 01/27/2023]
Abstract
Vertical sleeve gastrectomy (VSG), the most utilized bariatric procedure in clinical practice, greatly reduces body weight and improves a variety of metabolic disorders. However, one of its long-term complications is bone loss and increased risk of fracture. Elevated circulating sclerostin (SOST) and granulocyte-colony stimulating factor (G-CSF) concentrations have been considered as potential contributors to VSG-associated bone loss. To test these possibilities, we administrated antibodies to SOST or G-CSF receptor and investigated alterations to bone and marrow niche following VSG. Neutralizing either SOST or G-CSF receptor did not alter beneficial effects of VSG on adiposity and hepatic steatosis, and anti-SOST treatment provided a further improvement to glucose tolerance. SOST antibodies partially reduced trabecular and cortical bone loss following VSG by increasing bone formation, whereas G-CSF receptor antibodies had no effects on bone mass. The expansion in myeloid cellularity and reductions in bone marrow adiposity seen with VSG were partially eliminated by treatment with Anti-G-CSF receptor. Taken together, these experiments demonstrate that antibodies to SOST or G-CSF receptor may act through independent mechanisms to partially block effects of VSG on bone loss or marrow niche cells, respectively.
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Affiliation(s)
- Ziru Li
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America; MaineHealth Institute for Research, Scarborough, ME, United States of America
| | - Kevin Qiu
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America
| | - Jingtong Zhao
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America
| | - Katrina Granger
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America
| | - Hui Yu
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America
| | - Alfor G Lewis
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, United States of America
| | - Andriy Myronovych
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, United States of America
| | - Mouhamadoul H Toure
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, United States of America
| | - Sarah J Hatsell
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States of America
| | - Aris N Economides
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States of America
| | - Randy J Seeley
- University of Michigan Medical School, Department of Surgery, Ann Arbor, MI, United States of America
| | - Ormond A MacDougald
- University of Michigan Medical School, Department of Molecular & Integrative Physiology, Ann Arbor, MI, United States of America; University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, MI, United States of America.
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6
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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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Maxwell CV, Shirley R, O'Higgins AC, Rosser ML, O'Brien P, Hod M, O'Reilly SL, Medina VP, Smith GN, Hanson MA, Adam S, Ma RC, Kapur A, McIntyre HD, Jacobsson B, Poon LC, Bergman L, Regan L, Algurjia E, McAuliffe FM. Management of obesity across women's life course: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:35-49. [PMID: 36635081 PMCID: PMC10107516 DOI: 10.1002/ijgo.14549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
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Affiliation(s)
- Cynthia V Maxwell
- Maternal Fetal Medicine; Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rachelle Shirley
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy C O'Higgins
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian, New York, New York, USA
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of HealthUniversidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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8
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Sheikhhossein F, Amini MR, Askari M, Pourreza S, Hosseini F, Clark CCT, Djafarian K, Ghanbari M, Shab-Bidar S. The effects of capsinoids supplementation on body composition and anthropometric measures: A systematic review and dose-response meta-analysis of randomized controlled trials. Clin Nutr ESPEN 2022; 52:381-394. [PMID: 36513480 DOI: 10.1016/j.clnesp.2022.09.021] [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: 04/04/2021] [Revised: 07/21/2022] [Accepted: 09/19/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND & AIMS The present systematic review and meta-analysis was conducted to investigate the effects of capsinoids on body mass index (BMI), body weight (BW), waist circumference (WC), waist-hip ratio (WHR), fat mass (FM), fat-free mass (FFM), visceral fat area (VFA), and percentage body fat (PBF). METHODS Four databases were searched from inception to November 2020 using relevant keywords. All clinical trials investigating the effects of capsinoids supplementation on body composition and anthropometric measures were retained. RESULTS Overall, 19 effect sizes and 13 trials with a total sample size of 838 participants were included. Capsinoids supplementation had no effect on BW (P = 0.230), BMI (P = 0.182), WC (P = 0.611), FM (P = 0.946), FFM (P = 0.917), WHR (P = 0.599), VFA (P = 0.836), and PBF (P = 0.973). Findings from subgroup analysis revealed a significant reduction in BW in trials conducted on overweight participants, and lasted ≥12 weeks, However, no significant non-linear associations were found between capsinoids supplementation dosage and study duration with both BW (For dosage: Pnon-linearity = 0.527, for duration: Pnon-linearity = 0.410) and BMI (For dosage: Pnon-linearity = 0.308, for duration: Pnon-linearity = 0.578). CONCLUSION Capsinoids supplementation has no significant effect on obesity indicators. However, capsinoids in trials conducted on overweight participants, and lasted ≥12 weeks may have a significant and modest reduction in BW. Well-designed RCTs with larger sample size and longer duration are needed to confirm these results.
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Affiliation(s)
- Fatemeh Sheikhhossein
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Askari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sanaz Pourreza
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Fatemeh Hosseini
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Cain C T Clark
- Centre for Sport, Exercise, and Life Sciences, Coventry University, Coventry, CV15FB, UK
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Mahtab Ghanbari
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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9
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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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10
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Halin M, Allado E, Albuisson E, Brunaud L, Chary-Valckenaere I, Loeuille D, Quilliot D, Fauny M. Prevalence of Osteoporosis Assessed by DXA and/or CT in Severe Obese Patients. J Clin Med 2022; 11:jcm11206114. [PMID: 36294434 PMCID: PMC9605130 DOI: 10.3390/jcm11206114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/07/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Abstract
The primary objective was to evaluate bone fragility prevalence on dual X-ray absorptiometry (DXA) and computed tomography (CT) in patients with severe obesity. The secondary objective was to evaluate the risk factors for bone fragility. This monocentric study was conducted in patients with grade 2 and 3 obesity. Bone mineral density (BMD) and T-score were studied on DXA, and the scanographic bone attenuation coefficient of L1 (SBAC-L1) was measured on CT. Among the 1386 patients included, 1013 had undergone both DXA and CT within less than 2 years. The mean age was 48.4 (±11.4) years, 77.6% were women, and the mean BMI was 45.6 (±6.7) kg/m². Eight patients (0.8%) had osteoporosis in at least one site. The mean SBAC-L1 was 192.3 (±52.4) HU; 163 patients (16.1%) were under the threshold of 145 HU. Older age (OR[CI95] = 1.1 [1.08–1.16]), lower BMD on the femoral neck and spine (OR[CI95] = 0.04[0.005–0.33] and OR[CI95] = 0.001[0.0001–0.008], respectively), and higher lean mass (OR[CI95] = 1.1 [1.03–1.13]) were significantly associated with an SBAC-L1 ≤ 145 HU in multivariate analysis. Approximately 16% of patients with severe obesity were under the SBAC-L1 threshold, while less than 1% were classified as osteoporotic on DXA.
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Affiliation(s)
- Marion Halin
- Department of Rheumatology, University Hospital, F-54000 Nancy, France
| | - Edem Allado
- University Center of Sports Medicine and Adapted Physical Activity, CHRU-Nancy, F-54000 Nancy, France
- DevAH, Université de Lorraine, F-54000 Nancy, France
| | - Eliane Albuisson
- Unité de Méthodologie, Data Management et Statistiques (UMDS), Département MPI, DRCI, CHRU-Nancy, F-54000 Nancy, France
- IECL, CNRS, Université de Lorraine, F-54000 Nancy, France
| | - Laurent Brunaud
- Unité Multidisciplinaire de la Chirurgie de L’obésité (UMCO), University Hospital, F-54000 Nancy, France
- Inserm UMRS 1256 N-GERE (Nutrition-Genetics-Environmental Risks), Faculty of Medicine, University de Lorraine, F-54000 Nancy, France
- Department of Digestive, Hepato-Biliary and Endocrine Surgery, University Hospital, F-54000 Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of Rheumatology, University Hospital, F-54000 Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS—University of Lorraine, F-54000 Nancy, France
| | - Damien Loeuille
- Department of Rheumatology, University Hospital, F-54000 Nancy, France
- Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), UMR 7365 CNRS—University of Lorraine, F-54000 Nancy, France
| | - Didier Quilliot
- Unité Multidisciplinaire de la Chirurgie de L’obésité (UMCO), University Hospital, F-54000 Nancy, France
- Inserm UMRS 1256 N-GERE (Nutrition-Genetics-Environmental Risks), Faculty of Medicine, University de Lorraine, F-54000 Nancy, France
- Department of Endocrinology Diabetology and Nutrition, University Hospital, F-54000 Nancy, France
| | - Marine Fauny
- Department of Rheumatology, University Hospital, F-54000 Nancy, France
- Department of Rheumatology, Saint Charles Hospital, F-54200 Toul, France
- Correspondence:
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11
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Corsi GC, Pinheiro MCDA, Caldas APS, Dias MCG, Santo MA, Pajecki D. BONE HEALTH ASSESSMENT OF ELDERLY PATIENTS UNDERGOING BARIATRIC SURGERY. ARQUIVOS DE GASTROENTEROLOGIA 2022; 59:513-521. [PMID: 36515347 DOI: 10.1590/s0004-2803.202204000-91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bariatric surgery promotes changes in body composition, that can include the loss of bone mineral density (BMD). There is a lack of studies on the evolution of bone health of elderly people who underwent bariatric surgery, in general, and when comparing the gastric bypass (GB) and sleeve gastrectomy (SG) techniques. OBJECTIVE To evaluate the bone health of elderly patients with obesity undergoing bariatric surgery. METHODS This is a prospective randomized clinical study, that was carried out with individuals of both sexes, ≥65 years, undergoing GB or SG and who met the inclusion criteria. Age, gender and comorbidities (type 2 diabetes mellitus, arterial hypertension, dyslipidemia and osteoarthrosis) were collected and analyzed at baseline. Anthropometric data (weight, body mass index, percentage of weight loss, percentage of excess weight loss), laboratory tests related to bone health and bone mineral density were analyzed before and 24 months after surgery. RESULTS A total of 36 patients (GB, n=18; SG, n=18) were evaluated. At baseline, except for sex and preoperative body mass index, which was higher in GB, groups were similar. After 24 months, GB was superior for weight loss (%WL) and excess weight loss (%EWL). Regarding bone health, a significant decrease of BMD was observed in the spine, total proximal femur and femoral neck in all groups, with an average decrease of 5.1%, 10.5% and 15.1%, respectively. In addition, the observed decrease in BMD was up to 25% in the total femur after 24 months, six patients went from normal BMD to osteopenia and one from osteopenia to osteoporosis. There was no difference in parathormone values. However, there was an association between the increase in parathormone and the decrease in BMD in the spine, mainly in the GB group. There was no association between %WL and %EWL with the reduction in BMD. CONCLUSION Bariatric surgery was related to the reduction of BMD in elderly patients, but there was no statistical difference between the two surgical techniques.
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Affiliation(s)
- Giovanna Cavanha Corsi
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Moisés Carmo Dos Anjos Pinheiro
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Ana Paula Silva Caldas
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Maria Carolina Gonçalves Dias
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Divisão de Nutrição e Dietética, São Paulo, SP, Brasil
| | - Marco Aurelio Santo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
| | - Denis Pajecki
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Unidade de Cirurgia Bariátrica e Metabólica, Departamento de Gastroenterologia, Divisão Cirúrgica, São Paulo, SP, Brasil
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12
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Harris BT, Le PT, Da Silva Martins J, Alabdulaaly L, Baron R, Bouxsein ML, Rosen CJ, Pletch AN. Insulin-like growth factor binding protein 2 null mice (Igfbp2-/-) are protected against trabecular bone loss after vertical sleeve gastrectomy. Surg Endosc 2022; 36:6984-6996. [PMID: 35226161 DOI: 10.1007/s00464-022-09069-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Bariatric surgery has been shown to result in weight loss, improved hemoglobin A1C, and decreased mortality but can also lead to bone loss and increased fracture rates. Serum IGFBP-2 is elevated in patients after bariatric surgery and although it may lead to improved blood glucose, may also drive bone resorption, and inhibit IGF-I action. This study tested the hypothesis that Igfbp2-/- mice were acutely protected from bone loss after vertical sleeve gastrectomy (VSG). METHODS Thirty-four mice, 17 Igfbp2-/- and 17 + / + underwent a hand-sewn VSG or sham surgery, at 16 weeks of age. Mice were harvested at 20 weeks of age. DXA was measured for body composition, areal bone mineral density (aBMD), areal bone mineral content (aBMC), femoral bone mineral density (fBMD), and femoral bone mineral content (fBMC) at 15, 18, and 20 weeks of age. Micro-computed tomography and serum ELISA assays were measured and analyzed at 20 weeks of age. RESULTS Both Igfbp2-/- and + / + mice lost significant weight (P = 0.0251, P = 0.0003, respectively) and total fat mass (P = 0.0082, P = 0.0004, respectively) at 4 weeks after VSG. Igfbp2+/+ mice lost significant aBMD, fBMD, fBMC, trabecular BMD, trabecular BV/TV and cortical tissue mineral density (P = 0.0150, P = 0.0313, P = 0.0190, P = 0.0072, and 0.0320 respectively). The Igfbp2-/- mice did not show significant bone loss in these parameters nor in trabecular BV/TV. Both Igfbp2-/- and + / + mice had less cortical bone area (P = 0.0181, P = < .00001), cortical area over total area (P = 0.0085, P = 0.0007), and cortical thickness (P = 0.0050, P = < 0.0001), respectively. Igfbp2+/+ mice demonstrated significantly lower polar, minimum, and maximum moments of inertia (P = 0.0031, P = 0.0239, and P = 0.0037, respectively). Igfbp2+/+ had significantly higher levels of IGFBP-2 at 2 weeks postoperatively after VSG (P = 0.035), and elevated levels of CTx and P1NP (P = 0.0127, P = 0.0058, respectively). CONCLUSIONS Igfbp2-/- mice were protected against trabecular bone loss and had attenuated cortical bone loss 4 weeks after VSG.
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Affiliation(s)
- Benjamin T Harris
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, 04074, USA.
- College of Osteopathic Medicine, University of New England, Biddeford, ME, 04005, USA.
| | - Phuong T Le
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, 04074, USA
| | | | - Lama Alabdulaaly
- Division of Bone and Mineral Research, Harvard School of Dental Medicine, Boston, MA, 02115, USA
| | - Roland Baron
- Division of Bone and Mineral Research, Harvard School of Dental Medicine, Boston, MA, 02115, USA
- Department of Medicine and Endocrine Unit, Harvard Medical School, Massachusetts General Hospital, Boston, 02115, USA
| | - Mary L Bouxsein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Clifford J Rosen
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, 04074, USA
| | - Alison N Pletch
- Maine Medical Center Research Institute, Maine Medical Center, Scarborough, ME, 04074, USA
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13
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Ou X, Chen M, Xu L, Lin W, Huang H, Chen G, Wen J. Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis. Eur J Med Res 2022; 27:144. [PMID: 35934692 PMCID: PMC9358806 DOI: 10.1186/s40001-022-00774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm2, CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm2, CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm2, CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm2, CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm2, CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.
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Affiliation(s)
- Xiaodan Ou
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Mingguang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiac Intensive Care Unit, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Lizhen Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| | - Gang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
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14
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Paccou J, Caiazzo R, Lespessailles E, Cortet B. Bariatric Surgery and Osteoporosis. Calcif Tissue Int 2022; 110:576-591. [PMID: 33403429 DOI: 10.1007/s00223-020-00798-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023]
Abstract
It has been increasingly acknowledged that bariatric surgery adversely affects skeletal health. After bariatric surgery, the extent of high-turnover bone loss is much greater than what would be expected in the absence of a severe skeletal insult. Patients also experience a significant deterioration in bone microarchitecture and strength. There is now a growing body of evidence that suggests an association between bariatric surgery and higher fracture risk. Although the mechanisms underlying the high-turnover bone loss and increase in fracture risk after bariatric surgery are not fully understood, many factors seem to be involved. The usual suspects are nutritional factors and mechanical unloading, and the roles of gut hormones, adipokines, and bone marrow adiposity should be investigated further. Roux-en-Y gastric bypass (RYGB) was once the most commonly performed bariatric procedure worldwide, but sleeve gastrectomy (SG) has now become the predominant bariatric procedure. Accumulating evidence suggests that RYGB is associated with a greater reduction in BMD, a greater increase in markers of bone turnover, and a higher risk of fracture than SG. These findings should be taken into consideration in determining the most appropriate bariatric procedure for patients, especially those at higher fracture risk. Before and after all bariatric procedures, sufficient calcium, vitamin D and protein intake, and adequate physical activity, are needed to counteract negative impacts on bone. There are no studies to date that have evaluated the effect of osteoporosis treatment on high-turnover bone loss after bariatric surgery. However, in patients with a diagnosis of osteoporosis, anti-resorptive agents may be considered.
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Affiliation(s)
- Julien Paccou
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France.
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, 2, Avenue Oscar Lambret, 59037, Lille, France.
| | - Robert Caiazzo
- Inserm, Endocrine and Metabolic Surgery, UMR 1190, CHU Lille, Univ. Lille, 59000, Lille, France
| | - Eric Lespessailles
- Department of Rheumatology, CHR Orléans, I3MTO EA 4708, Univ. Orléans, 45067, Orléans, France
| | - Bernard Cortet
- Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France
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15
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Diniz-Sousa F, Granja T, Boppre G, Veras L, Devezas V, Santos-Sousa H, Preto J, Machado L, Vilas Boas JP, Oliveira J, Fonseca H. Effects of a Multicomponent Exercise Training Program on Balance Following Bariatric Surgery. Int J Sports Med 2022; 43:818-824. [PMID: 35419778 DOI: 10.1055/a-1766-5803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patients who undergo bariatric surgery (BS) have an increased risk of falls. Our aim was to determine if a multicomponent exercise intervention after BS improves balance. Eighty-four patients with obesity enrolled for BS were recruited and 1 month after BS randomly allocated to a control (CG; standard medical care) or exercise group (EG; exercise plus standard medical care) consisting of a supervised multicomponent training program (3d/week; 75 min/session; 5 months). Anthropometry, lower limb muscle strength (isokinetic dynamometer), vitamin D (ELISA) and balance in bipedal stance (force platform) were assessed pre-BS, 1 month and 6 months post-BS. One month post-BS, significant balance improvements were observed, namely in antero-posterior center of gravity (CoG) displacement and velocity, and medio-lateral and total CoG velocity. Between 1- and 6-months post-BS, improvements in balance were observed only in the EG, with a significant treatment effect on CoG displacement area and antero-posterior CoG displacement. No significant differences were observed between EG and CG over time in any of the anthropometric, muscle strength, and vitamin D variables assayed. In conclusion, a multicomponent exercise intervention program improves some balance parameters in patients with severe obesity following BS and therefore should be part of post-BS follow-up care as a potential strategy to reduce falls and associated injuries.
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Affiliation(s)
- Florêncio Diniz-Sousa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Tiago Granja
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Lucas Veras
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Vítor Devezas
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - Hugo Santos-Sousa
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - John Preto
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,General Surgery Department, São João Medical Center, Porto, Portugal
| | - Leandro Machado
- Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - Joao Paulo Vilas Boas
- Center of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Porto Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - Jose Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
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16
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Wu KC, Cao S, Weaver CM, King NJ, Patel S, Kingman H, Sellmeyer DE, McCauley K, Li D, Lynch SV, Kim TY, Black DM, Shafer MM, Özçam M, Lin DL, Rogers SJ, Stewart L, Carter JT, Posselt AM, Schafer AL. Prebiotic to Improve Calcium Absorption in Postmenopausal Women After Gastric Bypass: A Randomized Controlled Trial. J Clin Endocrinol Metab 2022; 107:1053-1064. [PMID: 34888663 PMCID: PMC8947782 DOI: 10.1210/clinem/dgab883] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT The adverse skeletal effects of Roux-en-Y gastric bypass (RYGB) are partly caused by intestinal calcium absorption decline. Prebiotics, such as soluble corn fiber (SCF), augment colonic calcium absorption in healthy individuals. OBJECTIVE We tested the effects of SCF on fractional calcium absorption (FCA), biochemical parameters, and the fecal microbiome in a post-RYGB population. METHODS Randomized, double-blind, placebo-controlled trial of 20 postmenopausal women with history of RYGB a mean 5 years prior; a 2-month course of 20 g/day SCF or maltodextrin placebo was taken orally. The main outcome measure was between-group difference in absolute change in FCA (primary outcome) and was measured with a gold standard dual stable isotope method. Other measures included tolerability, adherence, serum calciotropic hormones and bone turnover markers, and fecal microbial composition via 16S rRNA gene sequencing. RESULTS Mean FCA ± SD at baseline was low at 5.5 ± 5.1%. Comparing SCF to placebo, there was no between-group difference in mean (95% CI) change in FCA (+3.4 [-6.7, +13.6]%), nor in calciotropic hormones or bone turnover markers. The SCF group had a wider variation in FCA change than placebo (SD 13.4% vs 7.0%). Those with greater change in microbial composition following SCF treatment had greater increase in FCA (r2 = 0.72, P = 0.05). SCF adherence was high, and gastrointestinal symptoms were similar between groups. CONCLUSION No between-group differences were observed in changes in FCA or calciotropic hormones, but wide CIs suggest a variable impact of SCF that may be due to the degree of gut microbiome alteration. Daily SCF consumption was well tolerated. Larger and longer-term studies are warranted.
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Affiliation(s)
- Karin C Wu
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Correspondence: Karin C. Wu, MD, 1700 Owens St. RM 349, San Francisco, CA 94158, USA.
| | - Sisi Cao
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Department of Human Sciences, the Ohio State University, Columbus, OH 43210, USA
| | - Connie M Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| | - Nicole J King
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco, CA 94107, USA
| | - Hillary Kingman
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Deborah E Sellmeyer
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 94305, USA
| | - Kathryn McCauley
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Danny Li
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Susan V Lynch
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Tiffany Y Kim
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
| | - Martin M Shafer
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705, USA
| | - Mustafa Özçam
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Din L Lin
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Stanley J Rogers
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lygia Stewart
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
| | - Jonathan T Carter
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Andrew M Posselt
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Anne L Schafer
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA 94121, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94143, USA
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17
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Auge M, Menahem B, Savey V, Lee Bion A, Alves A. Long-term complications after gastric bypass and sleeve gastrectomy: What information to give to patients and practitioners, and why? J Visc Surg 2022; 159:298-308. [PMID: 35304081 DOI: 10.1016/j.jviscsurg.2022.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Bariatric surgery is now recognized as the most effective treatment of morbid obesity, leading to durable weight loss and resolution of associated co-morbidities. Roux-en-Y gastric bypass and sleeve gastrectomy are the two most widely used operations today. However, potentially serious medical, surgical, and/or psychiatric complications can occur that raise questions regarding the benefits of this type of surgery. These complications can lead to surgical re-operations, iterative hospitalizations, severe nutritional deficiencies and psychological disorders. Indeed, death from suicide is said to be three times higher than in non-operated obese patients. These results are of concern, all the more because of the high prevalence of patients lost to follow-up (for various and multifactorial reasons) after bariatric surgery. However, better knowledge of post-surgical sequelae could improve the information provided to patients, the preoperative evaluation of the benefit/risk ratio, and, for patients undergoing surgery, the completeness and quality of follow-up as well as the detection and management of complications. The development of new strategies for postoperative follow-up such as telemedicine but also the mobilization of all the actors along the healthcare pathway can make inroads and warrant further study.
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Affiliation(s)
- M Auge
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - B Menahem
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France.
| | - V Savey
- Service de nutrition, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Lee Bion
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - A Alves
- Department of visceral and digestive surgery, CHU Caen, avenue de la Côte-de-Nacre, 14000 Caen, France; Unité INSERM UMR1086, Normandie University, UNICAEN, centre François-Baclesse, 14045 Caen cedex, France
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18
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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19
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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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20
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Saad RK, Ghezzawi M, Habli D, Alami RS, Chakhtoura M. Fracture risk following bariatric surgery: a systematic review and meta-analysis. Osteoporos Int 2022; 33:511-526. [PMID: 34988627 DOI: 10.1007/s00198-021-06206-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022]
Abstract
Bariatric surgery may negatively impact bone health. We aimed to compare fracture risk following bariatric surgery by type (malabsorptive, restrictive), or to non-surgical weight loss, or to controls with obesity. We systematically searched four databases from inception until October 2020. We included observational and interventional studies on adults. We screened articles and abstracted data in duplicate and independently and assessed the risk of bias. We conducted random-effects model meta-analyses (Review Manager v5.3), to calculate the relative risk of any or site-specific fracture (CRD42019128536). We identified four trials of unclear-to-high risk of bias and 15 observational studies of fair-to-good quality. Data on fracture risk following bariatric surgery compared to medical weight loss is scarce and limited by the small number of participants. In observational studies, at a mean/median post-operative follow-up > 2 years, the relative risk of any fracture was 45% (p < 0.001) and 61% (p = 0.04) higher following malabsorptive procedures compared to obese controls and restrictive procedures, respectively, with moderate to high heterogeneity. Site-specific relative fracture risk (hip and wrist) was one- to two-folds higher post malabsorptive procedures compared to obese controls or restrictive procedures. The risks of any and of site-specific fracture were not increased following restrictive procedures compared to obese controls. Fracture risk seems to increase following malabsorptive bariatric surgeries, at a mean/median follow-up > 2 years. The risk is not increased with restrictive surgeries. The available evidence has several limitations. A prospective and rigorous long-term follow-up of patients following bariatric surgery is needed for a better assessment of their fracture risk with aging.
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Affiliation(s)
- R K Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Ghezzawi
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - D Habli
- Department of Clinical Nutrition, American University of Beirut Medical Center, Beirut, Lebanon
| | - R S Alami
- Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - M Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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21
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Liao J, Yin Y, Zhong J, Chen Y, Chen Y, Wen Y, Cai Z. Bariatric surgery and health outcomes: An umbrella analysis. Front Endocrinol (Lausanne) 2022; 13:1016613. [PMID: 36387921 PMCID: PMC9650489 DOI: 10.3389/fendo.2022.1016613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding the association between bariatric surgery and health-related outcomes using an umbrella review of meta-analyses. METHODS We systematically searched PubMed, Embase, and the Web of Science databases from inception until December 2, 2021, to identify meta-analyses of observational or interventional studies that investigated the association between bariatric surgery and multiple health outcomes. We extracted the summary effect size and 95% confidence interval (CI) data. The Assessment of Multiple Systematic Reviews (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used for methodological and evidence quality assessments, respectively. RESULTS Twenty-eight studies with 82 different health-related outcomes were included in this umbrella review. Beneficial effects of bariatric surgery have been observed in cancer incidence, mortality, cardiovascular risk, polycystic ovary syndrome (PCOS), anxiety symptoms, depressive symptoms, gestational diabetes mellitus, gestational hypertension, large for gestational age (LGA), macrosomia, post-term birth, risk of kidney stones, albuminuria, urinary incontinence, fecal incontinence, Barrett's esophagus, and diabetic retinopathy. However, adverse effects of bariatric surgery were observed for maternal anemia, perinatal mortality, congenital anomalies, preterm birth, neonatal intensive care unit (NICU) admission, intrauterine growth restriction, small for gestational age (SGA), fracture risk, upper limb fracture, suicide, self-harm, and alcohol use disorder (AUD). CONCLUSIONS Current evidence suggests that bariatric surgery improves the majority of health-related outcomes; however, caution is advised given it may increase the risk of adverse mental effects, perinatal problems, and fractures.
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Affiliation(s)
- Jing Liao
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yiqiong Yin
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Jing Zhong
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yanjun Chen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yanbing Chen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yue Wen
- Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Gastric Cancer Center, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Zhaolun Cai,
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22
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Mirhosseini Dehabadi S, Sayadi Shahraki M, Mahmoudieh M, Kalidari B, Melali H, Mousavi M, Ghourban Abadi M, Mirhosseini S. Bone health after bariatric surgery: Consequences, prevention, and treatment. Adv Biomed Res 2022; 11:92. [DOI: 10.4103/abr.abr_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 11/05/2022] Open
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23
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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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24
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Paccou J, Tsourdi E, Meier C, Palermo A, Pepe J, Body JJ, Zillikens MC. Bariatric surgery and skeletal health: A narrative review and position statement for management by the European Calcified Tissue Society (ECTS). Bone 2022; 154:116236. [PMID: 34688942 DOI: 10.1016/j.bone.2021.116236] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/02/2021] [Accepted: 10/16/2021] [Indexed: 12/14/2022]
Abstract
CONTEXT Numerous studies have demonstrated detrimental skeletal consequences following bariatric surgery. METHODS A working group of the European Calcified Tissue Society (ECTS) performed an updated review of existing literature on changes of bone turnover markers (BTMs), bone mineral density (BMD), and fracture risk following bariatric surgery and provided advice on management based on expert opinion. LITERATURE REVIEW Based on observational studies, bariatric surgery is associated with a 21-44% higher risk of all fractures. Fracture risk is time-dependent and increases approximately 3 years after bariatric surgery. The bariatric procedures that have a malabsorptive component (including Roux-en-Y Gastric bypass (RYGB) and biliopancreatic diversion (BPD)) have clearly been associated with the highest risk of fracture. The extent of high-turnover bone loss suggests a severe skeletal insult. This is associated with diminished bone strength and compromised microarchitecture. RYGB was the most performed bariatric procedure worldwide until very recently, when sleeve gastrectomy (SG) became more prominent. There is growing evidence that RYGB is associated with greater reduction in BMD, greater increase in BTMs, and higher risk of fractures compared with SG but RCTs on optimal management are still lacking. EXPERT OPINION In all patients, it is mandatory to treat vitamin D deficiency, to achieve adequate daily calcium and protein intake and to promote physical activity before and following bariatric surgery. In post-menopausal women and men older than 50 years, osteoporosis treatment would be reasonable in the presence of any of the following criteria: i) history of recent fragility fracture after 40 years of age, ii) BMD T-score ≤ -2 at hip or spine, iii) FRAX score with femoral neck BMD exceeding 20% for the 10-year major osteoporotic fracture probability or exceeding 3% for hip fracture. Zoledronate as first choice should be preferred due to intolerance of oral formulations and malabsorption. Zoledronate should be used with caution due to hypocemia risk. It is recommended to ensure adequate 25-OH vitamin D level and calcium supplementation before administering zoledronate. CONCLUSIONS The bariatric procedures that have a malabsorptive component have been associated with the highest turnover bone loss and risk of fracture. There is a knowledge gap on osteoporosis treatment in patients undergoing bariatric surgery. More research is necessary to direct and support guidelines.
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Affiliation(s)
- Julien Paccou
- Univ. Lille, CHU Lille, MABLab ULR 4490, Department of Rheumatology, 59000 Lille, France.
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Christian Meier
- Division of Endocrinology, Diabetes and Metabolism, University Hospital and University of Basel, Switzerland
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - Jessica Pepe
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, "Sapienza" University of Rome, Italy
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Carola Zillikens
- Bone Center Erasmus MC, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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Beavers KM, Beavers DP, Fernandez AZ, Greene KA, Swafford AA, Weaver AA, Wherry SJ, Ard JD. Risedronate use to attenuate bone loss following sleeve gastrectomy: Results from a pilot randomized controlled trial. Clin Obes 2021; 11:e12487. [PMID: 34569167 PMCID: PMC8563448 DOI: 10.1111/cob.12487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to explore the efficacy of 150 mg once monthly oral risedronate use in the prevention of sleeve gastrectomy (SG) associated bone loss. Twenty-four SG patients (56 ± 7 years, 83% female, 21% black) were randomized to risedronate or placebo for 6 months, with an optional 12-month assessment. Outcome measures included 6 (n = 21) and 12 (n = 14) month change in dual energy x-ray absorptiometry-acquired regional areal bone mineral density (aBMD). Six-month treatment effect estimates [mean (95% CI)] revealed significant between group aBMD differences at the femoral neck [risedronate: +0.013 g/cm2 (-0.021, 0.046) vs. placebo: -0.041 g/cm2 (-0.067, -0.015)] and lumbar spine [risedronate: +0.028 g/cm2 (-0.006, 0.063) vs. placebo: -0.029 g/cm2 (-0.054, -0.004)]; both p ≤ 0.02. When followed postoperatively to 12 months, differential aBMD treatment effects were observed at the total hip [risedronate: -0.035 g/cm2 (-0.061, -0.009) vs. placebo: -0.072 g/cm2 (-0.091, -0.052)] and lumbar spine [risedronate: +0.012 g/cm2 (-0.038, 0.063) vs. placebo: -0.052 g/cm2 (-0.087, -0.017)]; both p < 0.05. Preliminary treatment effect estimates signal 6 months of risedronate use may be efficacious in reducing aBMD loss at the axial skeleton post-SG, with benefit largely maintained throughout the 1-year postoperative period. Confirmatory data from an adequately powered trial are needed.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Daniel P. Beavers
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Adolfo Z. Fernandez
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Ashlyn A. Swafford
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Ashley A. Weaver
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sarah J. Wherry
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jamy D. Ard
- Weight Management Center, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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26
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Khalid SI, Thomson KB, Becerra AZ, Omotosho P, Spagnoli A, Torquati A. Rates, Risks, and Time to Fracture in Patients Undergoing Laparoscopic Vertical Sleeve Gastrectomy versus Roux-en-Y Gastric Bypass. ANNALS OF SURGERY OPEN 2021; 2:e099. [PMID: 37637884 PMCID: PMC10455321 DOI: 10.1097/as9.0000000000000099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the rates, risks, and time to fracture in patients undergoing laparoscopic vertical sleeve gastrectomy (VSG) versus those undergoing Roux-en-Y gastric bypass (RYGB). Summary Background Data Metabolic and bariatric surgery has been implicated in significant bone loss and may increase fracture risk. Preoperative patient characteristics that might impact fracture risk and the time to fractures have not been established. Furthermore, the patient characteristics that might impact fracture risk and the time to fractures by surgical approach are unknown. Methods This population-based retrospective cohort analysis used Humana claims data from January 1, 2007 to March 31, 2017, and included 4073 patients undergoing laparoscopic RYGB and VSG as a first surgical intervention for weight loss. The primary outcomes were the incidence of fractures (Humeral, Radial or Ulnar, Pelvic, Hip, and Vertebral) within 48 months after laparoscopic VSG versus RYGB and days to these fractures. Results An analysis of total fractures (odds ratio [OR] 0.53; 95% confidence interval [CI], 0.38-0.73), vertebral fractures (OR 0.61; 95% CI, 0.38-0.99), hip fractures (OR 0.36; 95% CI, 0.15-0.84), and humeral fractures (OR 0.44; 95% CI, 0.22-0.90) demonstrated a reduction in fracture risk in patients undergoing VSG versus RYGB. Furthermore, postmenopausal status was independently associated with increased odds of total fractures and hip fractures (OR 2.18; 95% CI, 1.06-4.50; OR 5.83; 95% CI, 1.16-29.27; respectively). Likewise, osteoporosis at the time of surgery was associated with increased odds of total fractures (OR 1.61; 95% CI, 1.09-2.37), vertebral fractures (OR 2.01; 95% CI, 1.19-3.39), and hip fractures (OR 2.38; 95% CI, 1.19-4.77). Except for a significantly decreased odds of vertebral fractures in osteoporotic patients undergoing VSG versus RYGB (OR 0.41; 95% CI, 0.18-0.95), osteoporotic or postmenopausal status at the time of surgery was not found to increase odds of fracture depending on surgical intervention. However, time to fracture (total) and for all site-specific fractures, except for pelvic fractures, was significantly reduced in postmenopausal women undergoing RYGB versus VSG. Time to fracture (total) and for all site-specific fractures except pelvic and radial or ulnar fractures was significantly reduced in osteoporotic patients undergoing RYGB versus VSG. Conclusions and Relevance Though bariatric surgery is associated with several health-related benefits, increased fracture risk is an important factor to discuss with patients undergoing bariatric surgery. Bariatric surgery strategy, RYGB versus VSG, carries a differential risk of fracture, with RYGB carrying a higher risk of fracture and decreased time to fracture. Furthermore, patients who are postmenopausal or osteoporotic at the time of surgery carry an increased risk of total fractures, independent of bariatric surgery strategy. Being mindful of patient-specific fracture risk after bariatric surgery may help anticipate, identify, and prevent fractures.
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Affiliation(s)
- Syed I. Khalid
- From the Department of Surgery, Rush University Medical Center, Chicago, IL
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL
| | | | - Adan Z. Becerra
- From the Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Philip Omotosho
- From the Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Anna Spagnoli
- From the Department of Surgery, Rush University Medical Center, Chicago, IL
| | - Alfonso Torquati
- From the Department of Surgery, Rush University Medical Center, Chicago, IL
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27
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Chaves Pereira de Holanda N, de Lima Carlos I, Chaves de Holanda Limeira C, Cesarino de Sousa D, Serra de Lima Junior FA, Telis de Vilela Araújo A, Peres Montenegro AC, Bandeira F. Fracture Risk After Bariatric Surgery: A Systematic Literature Review and Meta-Analysis. Endocr Pract 2021; 28:58-69. [PMID: 34563701 DOI: 10.1016/j.eprac.2021.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/05/2021] [Accepted: 09/16/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Bariatric surgery has undeniable benefits for cardiovascular and metabolic health, but it can result in negative effects on mineral and bone metabolism. This study aimed to review the current data on fractures after the main types of bariatric surgery. METHODS Therefore, a systematic review was performed using the electronic literature available in the databases LILACS, CENTRAL, Web of Science, Embase, and PubMed/MEDLINE, with results until January 2021. Keywords were descriptors for bariatric surgery or bariatric medicine or bariatrics or gastroplasty and bone or bones or bone fractures, referenced in all words of the text in the study. RESULTS The meta-analysis of observational studies and interventional trials showed that the risk of any type of fracture was higher in the surgical group than in the nonsurgical group (relative risk [RR], 1.20 [95% confidence interval {CI}, 1.15-1.26; P < .00001; Phetero < 0.000001; I2 = 94%], and RR, 1.16 [95% CI, 1.00-1.33; P = .04; Phetero = 0.27; I2 = 23%], respectively). It is worth noting that the included interventional studies have a low rating on the risk of bias assessment scales. Compared with those who underwent restrictive procedures, subjects had an increased fracture risk after malabsorptive procedures (RR, 0.49 [95% CI, 0.40-0.61; P < .00001); Phetero = 0.96; I2 = 0%). CONCLUSION We found that bariatric procedures are associated with an increased risk of fractures, especially the malabsorptive techniques.
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Affiliation(s)
- Narriane Chaves Pereira de Holanda
- Department of Endocrinology, Federal University of Paraiba, João Pessoa, Brazil; Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil.
| | | | | | | | | | | | | | - Francisco Bandeira
- Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil; Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil
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28
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Increased Fracture Risk After Bariatric Surgery: a Case-Controlled Study with a Long-Term Follow-Up. Obes Surg 2021; 31:4853-4860. [PMID: 34462846 PMCID: PMC8490253 DOI: 10.1007/s11695-021-05655-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Purpose Bariatric surgeries are common procedures due to the high prevalence of obesity. This study aimed to investigate whether bariatric surgery increases fracture risk. Material and Methods It was a case-controlled study. Patients who underwent bariatric surgery during 2011 and 2012 were matched for age (± 5 years) and gender to patients on medical weight management during the same period with a ratio of 1:2. The index date was defined as the date of bariatric surgery for both groups. The subject’s electronic medical records were reviewed retrospectively to identify fractures documented by radiology during January 2020. Results Randomly selected 403 cases were matched to 806 controls with a median age of 36.0 years (IQR 14.0) and 37.0 years (IQR 14.0), respectively. Seventy per cent of the cohort were females. Eighty per cent received sleeve gastrectomy, and the remaining (17%) underwent gastric bypass. The mean duration of follow-up was 8.6 years. The fracture rate was higher in the surgical group as compared to the controls (9.4% vs 3.5%) with a crude odds ratio of 2.71 (95% CI 1.69–4.36). The median duration for time to fracture was 4.17 years for the surgical group and 6.09 years for controls (p-value = 0.097). The most common site of fractures was feet, followed by hands. Apart from a few wrist fractures, there was no typical osteoporotic sites fracture. Conclusion Subjects who underwent bariatric procedures had more non-typical osteoporotic site fractures affecting mainly feet and hands, and fractures tend to occur earlier as compared to controls. Graphical abstract ![]()
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29
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Tu Y, Bao Y, Zhang P. Metabolic surgery in China: present and future. J Mol Cell Biol 2021; 13:mjab039. [PMID: 34240190 PMCID: PMC8697345 DOI: 10.1093/jmcb/mjab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/27/2021] [Accepted: 06/14/2021] [Indexed: 11/24/2022] Open
Abstract
Obesity and its related complications comprise a serious public health problem worldwide, and obesity is increasing in China. Metabolic surgery is a new type of treatment with unique advantages in weight loss and obesity-related metabolic complications. The pathogenesis of obesity is complex and not yet fully understood. Here, we review the current efficacy and safety of metabolic surgery, as well as recent progress in mechanistic studies and surgical procedures in China. The exciting and rapid advances in this field provide new opportunities for patients with obesity and strike a balance between long-term effectiveness and safety.
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Affiliation(s)
- Yinfang Tu
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai
Jiao Tong University Affiliated Sixth People’s HospitalShanghai Diabetes
Institute, Shanghai Clinical Center of Diabetes, Shanghai Key Laboratory of
Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic
Disease, Shanghai 200233, China
- Department of Endocrinology and Metabolism, Jinshan
District Central Hospital of Shanghai Sixth People's
Hospital, Shanghai 201599, China
| | - Pin Zhang
- Department of Bariatric and Metabolic Surgery,
Shanghai Jiao Tong University Affiliated Sixth People’s
Hospital, Shanghai 200233, China
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30
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Cui B, Sun X, Li W, Li P, Wang G, Yu Z, Tang H, Ling J, Yi X, Zhu L, Zhu S. Five-year Changes in Body Composition in Type 2 Diabetes Mellitus Patients with a BMI < 32.5 kg/m 2 Undergoing Laparoscopic Roux-en-Y Gastric Bypass Surgery. Obes Surg 2021; 31:3565-3570. [PMID: 33909267 DOI: 10.1007/s11695-021-05430-w] [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: 01/10/2021] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Information is scarce on the five-year effect of laparoscopic Roux-en-Y Gastric Bypass (LRYGB) on body composition for Type 2 diabetes mellitus (T2DM) patients with a low BMI. This study aimed to evaluate the five-year changes in body composition in a Chinese T2DM cohort with a BMI < 32.5 kg/m2 after LRYGB. METHODS Twenty-seven T2DM patients were assessed preoperatively (baseline) and 3 months, 6 months, 1 year, 3 years, and 5 years after LRYGB with dual-energy X-ray absorptiometry (DXA). RESULTS DXA assessments were completed in 100%, 85%, 85%, 85%, 48%, and 37% at baseline and 3 months, 6 months, 1 year, 3 years, and 5 years, respectively. For the whole body, fat-free mass and muscle mass decreased from 6 months to 5 years after LRYGB (P < 0.05), while bone mineral content decreased at 5 years after LRYGB (P < 0.05). Fat mass of different regions decreased from 3 months to 1 year (P < 0.05), and a similar magnitude of variation was observed in body fat mass percentage. A fat redistribution characterized by the regional fat proportion of trunk and android decreasing and the regional fat proportion of limbs gaining (P < 0.05) occurred at 5 years after LRYGB. CONCLUSION For low BMI patients with T2DM, LRYGB led to a short-term reduction in FM and a lasting reduction in FFM. A metabolically healthy fat redistribution occurring 5 years after LRYGB might be a promising mechanism to explain the lasting benefits of LRYGB for T2DM patients with a low BMI.
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Affiliation(s)
- Beibei Cui
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Xulong Sun
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Weizheng Li
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Pengzhou Li
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Guohui Wang
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Zhaomei Yu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Haibo Tang
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Jiapu Ling
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Xianhao Yi
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China
| | - Liyong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
| | - Shaihong Zhu
- Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan, China.
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31
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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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Diniz-Sousa F, Veras L, Boppre G, Devezas V, Santos-Sousa H, Preto J, Machado L, Vilas-Boas JP, Oliveira J, Fonseca H. How Does Bariatric Surgery Affect Fall Risk Factors? Obes Surg 2021; 31:3506-3513. [PMID: 33797733 DOI: 10.1007/s11695-021-05400-2] [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: 01/14/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study aimed to assess bariatric surgery (BS) effect on fall risk factors. MATERIALS AND METHODS Fifteen patients undergoing BS (intervention group, IG) and 10 non-surgical obese patients (control group, CG) were recruited. IG was assessed at pre-surgery and 6 months after BS, while CG was assessed at baseline and reassessed after 6 months. At both time-points, anthropometry, lower limbs muscle strength (isokinetic dynamometer), balance in bipedal stance (force platform), daily physical activity (accelerometry), and health-related quality of life (SF-36 questionnaire) were assessed. RESULTS At baseline, there were no differences between CG and IG for all parameters analyzed. Compared to CG, 6 months post-BS, the IG decreased weight, body mass index, waist and hip circumference. Balance showed limited improvements, with gains observed only on antero-posterior and total center of pressure velocity. Muscle strength displayed a divergent evolution 6 months after BS, with a decrease in absolute strength but an increase in relative strength. Although BS did not induce significant changes in time spent in different physical activity intensities, it decreased time in sedentary behavior and increased number of daily steps. Post-BS patients reported substantial improvements in quality-of-life, especially in physical function. CONCLUSION Patients seem to overestimate their actual physical fitness improvements attained after BS, which combined with increases in physical activity, might increase the likelihood of engaging in risky daily tasks to what they are physically not prepared to, consequently increasing fall risk.
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Affiliation(s)
- Florêncio Diniz-Sousa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450, Porto, Portugal.
| | - Lucas Veras
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450, Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450, Porto, Portugal
| | - Vítor Devezas
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - Hugo Santos-Sousa
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - John Preto
- General Surgery Department, São João Medical Center, Porto, Portugal
| | - Leandro Machado
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - João P Vilas-Boas
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal.,Biomechanics Laboratory (LABIOMEP-UP), University of Porto, Porto, Portugal
| | - José Oliveira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450, Porto, Portugal
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Rua Dr. Plácido Costa, 91, 4200-450, Porto, Portugal
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33
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Krez A, Agarwal S, Bucovsky M, McMahon DJ, Hu Y, Bessler M, Schrope B, Carrelli A, Clare S, Guo XDE, Silverberg SJ, Stein EM. Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women. J Clin Endocrinol Metab 2021; 106:e1868-e1879. [PMID: 33098299 PMCID: PMC8502471 DOI: 10.1210/clinem/dgaa654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN Four-year prospective cohort study. PATIENTS African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.
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Affiliation(s)
- Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mariana Bucovsky
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Beth Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Carrelli
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shannon Clare
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Shonni J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Correspondence and Reprint Requests: Emily M. Stein, MD, MS, Director of Research, Metabolic Bone Service, Hospital for Special Surgery, Associate Professor of Medicine, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021. E-mail:
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Nuzzo A, Czernichow S, Hertig A, Ledoux S, Poghosyan T, Quilliot D, Le Gall M, Bado A, Joly F. Prevention and treatment of nutritional complications after bariatric surgery. Lancet Gastroenterol Hepatol 2021; 6:238-251. [PMID: 33581762 DOI: 10.1016/s2468-1253(20)30331-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 12/19/2022]
Abstract
Obesity and the corresponding burden of related diseases is a major public health issue worldwide that is reaching pandemic proportions. Bariatric surgery is the only intervention that has been shown to result in substantial and lasting weight loss, and a decrease in overall mortality for patients with severe obesity. Consequently, the population of patients having undergone this procedure is increasing. Multifactorial weight-dependent and independent mechanisms underlying metabolic diseases could also drive preventable, but potentially life-threatening, long-term nutritional complications. However, given post-bariatric patients are prone to functional gastrointestinal symptoms and substantial weight loss, nutritional complications might be challenging. This Review is focused on the prevention and treatment of nutritional complications after bariatric surgery in the clinical setting.
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Affiliation(s)
- Alexandre Nuzzo
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France
| | - Sebastien Czernichow
- Université de Paris, Paris, France; AP-HP, Service de Nutrition, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR 1153, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité, Paris, France
| | - Alexandre Hertig
- AP-HP, Department of Nephrology, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Séverine Ledoux
- Université de Paris, Paris, France; AP-HP, Service des Explorations Fonctionnelles, Centre Spécialisé Obésité, Hôpital Louis Mourier, Colombes, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Tigran Poghosyan
- Université de Paris, Paris, France; Service de Chirurgie Digestive, Oncologique et Bariatrique, Centre Spécialisé Obésité, Hôpital Européen Georges Pompidou, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Didier Quilliot
- Unité Multidisciplinaire de Chirurgie de l'Obésité, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre les Nancy Cedex, France
| | - Maude Le Gall
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - André Bado
- Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France
| | - Francisca Joly
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Gastroenterology, IBD and Intestinal Failure, Beaujon Hospital, Clichy, France; Université de Paris, Paris, France; INSERM, UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Paris, France.
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Alejo Ramos M, Ballesteros Pomar MD, Urioste Fondo AM, González Herráez L, González de Francisco T, Sierra Vega M, Cano Rodríguez IM. Bone metabolism and fracture risk after Biliopancreatic Diversion. ENDOCRINOL DIAB NUTR 2021; 68:144-152. [PMID: 34167693 DOI: 10.1016/j.endien.2021.06.003] [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: 07/28/2019] [Accepted: 08/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and β-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.
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Affiliation(s)
- Mirian Alejo Ramos
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Spain.
| | | | - Ana M Urioste Fondo
- Department of Endocrinology and Nutrition, Complejo Asistencial Universitario de León, Spain
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Bone metabolism and fracture risk after Biliopancreatic Diversion. ACTA ACUST UNITED AC 2021; 68:144-152. [PMID: 33495111 DOI: 10.1016/j.endinu.2020.08.005] [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: 07/28/2019] [Revised: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bariatric surgery (BS) is an effective treatment. However, there have been concerns regarding the negative effect on the bone. The aim of this study was to assess changes in bone metabolism and the risk of fracture after biliopancreatic diversion (BPD). MATERIAL AND METHODS A retrospective analysis of obese patients undergoing BPD between 1998 and 2017 was conducted, and patients with at least 1 year of follow-up were included. The incidence of fracture and of changes in bone metabolism was studied. RESULTS In total, 216 patients were included (78.2% female), with a mean age of 42.5(10.6) years. The median follow-up was 6.8(IQR 10.2-3.2) years. The mean body mass index (BMI) was 49.7(6.3) kg/m2. 13.2% (n=29) suffered a bone fracture after surgery; the time until the first fracture was 7.9(3.8) years (55.2% secondary to a casual fall). The rate of fracture incidence was 19.6 per 1000 person-years (95%CI: 1.3-2.7), prevalence was 13.4% (95%CI: 8.9-18.0). The risk of bone fractures seems to increase with longer postoperative evolution time. PTH (pg/ml) levels were significantly higher in patients with fractures (1 year, 98.1 vs. 77.8; 5 years, 162.5 vs. 110.3 p<0.05, adjusted HR 1.10; 95%CI 1.01-1.11). Subjects with a higher %EWL had less risk of fractures after surgery (adjusted HR 0.97; 95%CI 0.94-0.99). Moreover, 25(OH)D levels were lower, and osteocalcin and β-Crosslaps levels were slightly higher (not significant) in patients with fractures. CONCLUSION BPD is related to important changes in bone metabolism, which can lead to an increased risk of bone fractures. Assessing the risk of fractures should be part of BS patient care.
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Beavers KM, Greene KA, Yu EW. MANAGEMENT OF ENDOCRINE DISEASE: Bone complications of bariatric surgery: updates on sleeve gastrectomy, fractures, and interventions. Eur J Endocrinol 2020; 183:R119-R132. [PMID: 32869608 PMCID: PMC8254876 DOI: 10.1530/eje-20-0548] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
Despite well recognized improvements in obesity-related comorbidities, increasing evidence implicates bariatric surgery in the onset of adverse skeletal health outcomes. The purpose of this review is to provide a focused update in three critical areas: (i) emergent data on sleeve gastrectomy and bone loss, (ii) evidence linking bariatric surgery to incident fracture, and (iii) intervention strategies designed to mitigate surgical bone loss. Better understanding of these issues will inform our treatment of skeletal health for patients planning bariatric surgery.
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Affiliation(s)
- Kristen M. Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Katelyn A. Greene
- Department of Biomedical Engineering, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine W. Yu
- Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Swafford AA, Ard JD, Beavers DP, Gearren PC, Fernandez AZ, Ford SA, Greene KA, Kammire DE, Nesbit BA, Reed KK, Weaver AA, Beavers KM. Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial. JBMR Plus 2020; 4:e10407. [PMID: 33103032 PMCID: PMC7574708 DOI: 10.1002/jbm4.10407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/29/2020] [Accepted: 08/12/2020] [Indexed: 12/12/2022] Open
Abstract
Mounting evidence implicates bariatric surgery as a cause of increased skeletal fragility and fracture risk. Bisphosphonate therapy reduces osteoporotic fracture risk and may be effective in minimizing bone loss associated with bariatric surgery. The main objective of this pilot randomized controlled trial (RCT; Clinical Trial No. NCT03411902) was to determine the feasibility of recruiting, treating, and following 24 older patients who had undergone sleeve gastrectomy in a 6 month RCT examining the efficacy of 150‐mg once‐monthly risedronate (versus placebo) in the prevention of surgical weight‐loss–associated bone loss. Feasibility was defined as: (i) >30% recruitment yield, (ii) >80% retention, (iii) >80% pills taken, (iv) <20% adverse events (AEs), and (v) >80% participant satisfaction. Study recruitment occurred over 17 months. Seventy participants were referred, with 24 randomized (34% yield) to risedronate (n = 11) or placebo (n = 13). Average age was 56 ± 7 years, 83% were female (63% postmenopausal), and 21% were black. The risedronate group had a higher baseline BMI than the placebo group (48.1 ± 7.2 versus 41.9 ± 3.8 kg/m2). The 10‐year fracture risk was low (6.0% major osteoporotic fracture, 0.4% hip fracture); however, three individuals (12.5%, all risedronate group) were osteopenic at baseline. Twenty‐one participants returned for 6‐month follow‐up testing (88% retention) with all (n = 3) loss to follow‐up occurring in the risedronate group. Average number of pills taken among completers was 5.9 ± 0.4 and 6.0 ± 0.0 in the risedronate and placebo groups, respectively (p = 0.21), with active participants taking >80% of allotted pills. Five AEs (3.7% AE rate) were reported; one definitely related, four not related, and none serious. All participants reported high satisfaction with participation in the study. Use of bisphosphonates as a novel therapeutic to preserve bone density in patients who had undergone a sleeve gastrectomy appears feasible and well‐tolerated. Knowledge gained from this pilot RCT will be used to inform the design of an appropriately powered trial. Clinical Trial Registration http://clinicaltrials.gov/show/NCT03411902. Weight Loss With Risedronate for Bone Health. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Ashlyn A Swafford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Jamy D Ard
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Daniel P Beavers
- Department of Biostatistics and Data Science Wake Forest School of Medicine Winston-Salem NC USA
| | - Peri C Gearren
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Adolfo Z Fernandez
- Weight Management Center Wake Forest Baptist Medical Center Winston-Salem NC USA
| | - Sherri A Ford
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Katelyn A Greene
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Daniel E Kammire
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Beverly A Nesbit
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Kylie K Reed
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
| | - Ashley A Weaver
- Department of Biomedical Engineering Wake Forest School of Medicine Winston-Salem NC USA
| | - Kristen M Beavers
- Deparment of Health and Exercise Science Wake Forest University Winston-Salem NC USA
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Martínez-Ortega AJ, Olveira G, Pereira-Cunill JL, Arraiza-Irigoyen C, García-Almeida JM, Irles Rocamora JA, Molina-Puerta MJ, Molina Soria JB, Rabat-Restrepo JM, Rebollo-Pérez MI, Serrano-Aguayo MP, Tenorio-Jiménez C, Vílches-López FJ, García-Luna PP. Recommendations Based on Evidence by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) for the Pre- and Postoperative Management of Patients Undergoing Obesity Surgery. Nutrients 2020; 12:E2002. [PMID: 32640531 PMCID: PMC7400832 DOI: 10.3390/nu12072002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/24/2020] [Accepted: 07/02/2020] [Indexed: 12/13/2022] Open
Abstract
In order to develop evidence-based recommendations and expert consensus for nutrition management of patients undergoing bariatric surgery and postoperative follow-up, we conducted a systematic literature search using PRISMA methodology plus critical appraisal following the SIGN and AGREE-II procedures. The results were discussed among all members of the GARIN group, and all members answered a Likert scale questionnaire to assess the degree of support for every recommendation. Patients undergoing bariatric surgery should be screened preoperatively for some micronutrient deficiencies and treated accordingly. A VLCD (Very Low-Calorie Diet) should be used for 4-8 weeks prior to surgery. Postoperatively, a liquid diet should be maintained for a month, followed by a semi-solid diet also for one month. Protein requirements (1-1.5 g/kg) should be estimated using adjusted weight. Systematic use of specific multivitamin supplements is encouraged. Calcium citrate and vitamin D supplements should be used at higher doses than are currently recommended. The use of proton-pump inhibitors should be individualised, and vitamin B12 and iron should be supplemented in case of deficit. All patients, especially pregnant women, teenagers, and elderly patients require a multidisciplinary approach and specialised follow-up. These recommendations and suggestions regarding nutrition management when undergoing bariatric surgery and postoperative follow-up have direct clinical applicability.
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Affiliation(s)
- Antonio J. Martínez-Ortega
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Gabriel Olveira
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga/Universidad de Málaga, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- CIBERDEM (CB07/08/0019), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - José L. Pereira-Cunill
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | | | - José M. García-Almeida
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain;
- Unidad de gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
| | | | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain;
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | | | - María I. Rebollo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - María P. Serrano-Aguayo
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
| | - Carmen Tenorio-Jiménez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain;
| | | | - Pedro P. García-Luna
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (A.J.M.-O.); (J.L.P.-C.); (M.P.S.-A.); (P.P.G.-L.)
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBiS), 41007 Sevilla, Spain
- GARIN Group Coordinator, 41007 Seville, Spain
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Lingamfelter M, Orozco FR, Beck CN, Harrer MF, Post ZD, Ong AC, Ponzio DY. Nutritional Counseling Program for Morbidly Obese Patients Enables Weight Optimization for Safe Total Joint Arthroplasty. Orthopedics 2020; 43:e316-e322. [PMID: 32501522 DOI: 10.3928/01477447-20200521-08] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 05/06/2019] [Indexed: 02/03/2023]
Abstract
Obesity affects one-third of total joint arthroplasty (TJA) patients and is the most common modifiable risk factor for increased complications in the TJA population. The authors' institution implemented a body mass index (BMI) cutoff of 40 kg/m2 to define appropriate TJA candidates. Patients above the cutoff were referred for nutritional counseling. The study objective was to evaluate the efficacy of this protocol in optimizing patient BMI for safe and successful TJA. Between 2016 and 2018, the authors examined 133 patients (mean age, 62.6 years) with a BMI greater than 40 kg/m2 seeking TJA (94 knee, 39 hip) seen by an arthroplasty surgeon and then a dietitian. Outcomes included weight loss, change in BMI, duration of counseling, and surgical status. For postoperative patients, 90-day complications were recorded. A total of 102 (92%) patients achieved weight loss during a mean 154 days (range, 8-601 days). Patients lost a mean of 17 lb, lowering their BMI by 2.7 points (range, +6.3 to -17.7 points). Twenty-two patients discontinued nutritional counseling after 1 visit, most commonly secondary to cost when not covered by insurance. Seventy-one patients successfully underwent TJA, representing 64% of those patients who participated in nutritional counseling. Complications included delayed wound healing (n=2), periprosthetic fracture (n=2), infection (n=1), cellulitis (n=1), and peroneal nerve palsy (n=1). Surgeons must actively counsel obese patients about weight optimization as part of the preoperative standard of care. Nutritional counseling with a dietitian and follow-up with the surgeon translated to safe and successful TJA in a majority of patients. [Orthopedics. 2020;43(4):e316-e322.].
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Corbeels K, Verlinden L, Lannoo M, Khalil R, Deleus E, Mertens A, Matthys C, Verstuyf A, Meulemans A, Vangoitsenhoven R, Carmeliet G, Van der Schueren B. The curious fate of bone following bariatric surgery: bone effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in mice. Int J Obes (Lond) 2020; 44:2165-2176. [PMID: 32546862 DOI: 10.1038/s41366-020-0626-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Bone loss and increased fracture risk following bariatric surgery has been reported. We investigated whether the two most commonly performed surgeries, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), lead to bone loss. In addition, we examined whether fortification of the diet with calcium citrate prevents bone loss. METHODS We used mouse models for SG and RYGB and compared bone loss with a group of sham mice with similar weight loss. All groups were switched at the time of surgery to a low-fat diet (LFD). We also examined whether fortification of the diet with calcium citrate and vitamin D was able to prevent bone loss. RESULTS At 2 weeks we observed no major bone effects. However, at 8 weeks, both trabecular and cortical bone were lost to the same extent after SG and RYGB, despite increased calcium absorption and adequate serum levels of calcium, vitamin D, and parathyroid hormone (PTH). Diet fortification with calcium citrate and vitamin D was able to partially prevent bone loss. CONCLUSIONS Both SG and RYGB lead to excess bone loss, despite intestinal adaptations to increase calcium absorption. Fortifying the diet with calcium citrate and vitamin D partly prevented the observed bone loss. This finding emphasizes the importance of nutritional support strategies after bariatric surgery, but also affirms that the exact mechanisms leading to bone loss after bariatric surgery remain elusive and thus warrant further research.
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Affiliation(s)
- Katrien Corbeels
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.
| | - Lieve Verlinden
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Matthias Lannoo
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Rougin Khalil
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Ellen Deleus
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ann Mertens
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Annemieke Verstuyf
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Ann Meulemans
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Geert Carmeliet
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium
| | - Bart Van der Schueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium.,Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Guerrero-Pérez F, Casajoana A, Gómez-Vaquero C, Virgili N, López-Urdiales R, Hernández-Montoliu L, Pujol-Gebelli J, Osorio J, Prats A, Vidal-Alabró A, Pérez-Maraver M, Fernández-Veledo S, Vendrell J, Vilarrasa N. Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial. J Clin Med 2020; 9:jcm9061830. [PMID: 32545353 PMCID: PMC7356739 DOI: 10.3390/jcm9061830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Anna Casajoana
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Carmen Gómez-Vaquero
- Department of Rheumatology, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Rafael López-Urdiales
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Laura Hernández-Montoliu
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
| | - Jordi Pujol-Gebelli
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Javier Osorio
- Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (A.C.); (J.P.-G.); (J.O.)
| | - Anna Prats
- Clinical Nutrition Unit, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Anna Vidal-Alabró
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Manuel Pérez-Maraver
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- Instituto de Investigación Biomédica-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
| | - Sonia Fernández-Veledo
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Joan Vendrell
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Pere Virgili Research Institute (IISPV), University Hospital Joan XXIII, 43005and Rovira i Virgili University, 43003 Tarragona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (F.G.-P.); (N.V.); (R.L.-U.); (L.H.-M.); (M.P.-M.)
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, 28014 Madrid, Spain; (S.F.-V.); (J.V.)
- Correspondence: ; Tel.: +34-932-602-784
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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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Syn NL, Lee PC, Kovalik JP, Tham KW, Ong HS, Chan WH, Tan CS, Lim CH. Associations of Bariatric Interventions With Micronutrient and Endocrine Disturbances. JAMA Netw Open 2020; 3:e205123. [PMID: 32515795 PMCID: PMC7284307 DOI: 10.1001/jamanetworkopen.2020.5123] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Few studies have described the longitudinal trajectories of serum levels of micronutrients whose deficiencies are associated with serious sequelae following bariatric procedures, such as anemia, osteoporotic fractures, and neuropathies. Furthermore, previous studies comparing laparoscopic sleeve gastrectomy (LSG) vs Roux-en-Y gastric bypass (LRYGB) or one-anastomosis gastric bypass (OAGB) procedures may have been limited by selection and confounding biases. OBJECTIVE To appraise the spectrum and temporal course of micronutrient deficiencies associated with bone metabolism and erythropoiesis after LSG vs OAGB or LRYGB procedures, using the propensity score as a balancing score. DESIGN, SETTING, AND PARTICIPANTS This prospective, longitudinal comparative effectiveness study was conducted at a high-volume bariatric unit in Singapore from September 1, 2008, to November 30, 2017, with a cutoff date for analysis of September 2018. Patients who underwent adjustable gastric banding, biliopancreatic diversion procedures, and intragastric balloon procedures were excluded. All other patients who underwent bariatric procedures were included. Data were analyzed from September 23 to 30, 2018. MAIN OUTCOMES AND MEASURES Serial assessment of 13 biochemical parameters at 12 time points for up to 5 years after bariatric procedure. Inverse probability-of-treatment weights were used to obtain estimates of the mean associations of variables assessed with the bariatric surgical interventions. Longitudinal trajectories were analyzed using mixed-effects generalized linear models to apportion the temporal variation of serum micronutrients into fixed-effects and random-effects components. RESULTS A total of 688 patients were included in this study, of whom 499 underwent LSG (mean [SD] age, 41.5 [11.3] years; 318 [63.7%] women) and 189 underwent OAGB or LRYGB (mean [SD] age, 48.6 [9.4] years; 112 [59.3%] women). There were no differences during follow-up among patients who underwent LSG vs those who underwent OAGB or LRYGB in intact parathyroid hormone levels (mean difference, 7.05 [95% CI, -28.67 to 42.77] pg/mL; P = .70), serum 25-hydroxyvitamin D levels (mean difference, -0.72 [95% CI, -1.56 to 0.12] ng/mL; P = .09), or phosphate levels (mean difference, 0.006 [95% CI, -0.052 to 0.064] mg/dL; P = .83). Hemoglobin levels were a mean 0.63 (95% CI, 0.41 to 0.85) g/dL higher among patients who underwent LSG compared with those who underwent OAGB or LRYGB (P < .001), despite no differences in iron concentration levels (mean difference, 1.50 [95% CI, -1.39 to 4.39] µg/dL; P = .31), total iron-binding capacity (mean difference, 4.36 [95% CI, -5.25 to 13.98] µg/dL; P = .37), or ferritin levels (mean difference, 3.0 [95% CI, -13.0 to 18.9] ng/mL; P = .71). Compared with patients who underwent LSG procedures, patients who underwent OAGB or LRYGB had higher folate levels (mean difference, 2.376 [95% CI, 1.716 to 3.036] ng/mL; P < .001) but lower serum magnesium levels (mean difference, -0.25 [95% CI, -0.35 to -0.16] mg/dL; P < .001) and zinc levels (mean difference, -7.58 [95% CI, -9.92 to -5.24] µg/dL; P < .001). CONCLUSIONS AND RELEVANCE These findings suggest that LSG vs OAGB or LRYGB procedures have differential associations with various micronutrient and metabolic parameters. These differences should be recognized in guidelines for postbariatric nutritional surveillance and prevention.
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Affiliation(s)
- Nicholas L. Syn
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Phong Ching Lee
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Jean-Paul Kovalik
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
- Cardiovascular and Metabolic Diseases Programme, Duke-NUS Medical School, Singapore
| | - Kwang Wei Tham
- Department of Endocrinology, Division of Medicine, Singapore General Hospital, Singapore
| | - Hock Soo Ong
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Weng Hoong Chan
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
| | - Chuen Seng Tan
- Biostatistics and Modelling Domain, Saw Swee Hock School of Public Health, National University Health System, Singapore
| | - Chin Hong Lim
- Department of Upper Gastrointestinal and Bariatric Surgery, Singapore General Hospital, Singapore
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Ahlin S, Peltonen M, Sjöholm K, Anveden Å, Jacobson P, Andersson-Assarsson JC, Taube M, Larsson I, Lohmander LS, Näslund I, Svensson PA, Carlsson LMS. Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow-up of a controlled intervention study. J Intern Med 2020; 287:546-557. [PMID: 32128923 DOI: 10.1111/joim.13020] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies have reported an increased fracture risk after bariatric surgery. OBJECTIVE To investigate the association between different bariatric surgery procedures and fracture risk. METHODS Incidence rates and hazard ratios for fracture events were analysed in the Swedish Obese Subjects study; an ongoing, nonrandomized, prospective, controlled intervention study. Hazard ratios were adjusted for risk factors for osteoporosis and year of inclusion. Information on fracture events were captured from the Swedish National Patient Register. The current analysis includes 2007 patients treated with bariatric surgery (13.3% gastric bypass, 18.7% gastric banding, and 68.0% vertical banded gastroplasty) and 2040 control patients with obesity matched on group level based on 18 variables. Median follow-up was between 15.1 and 17.9 years for the different treatment groups. RESULTS During follow-up, the highest incidence rate for first-time fracture was observed in the gastric bypass group (22.9 per 1000 person-years). The corresponding incidence rates were 10.4, 10.7 and 9.3 per 1000 person-years for the vertical banded gastroplasty, gastric banding and control groups, respectively. The risk of fracture was increased in the gastric bypass group compared with the control group (adjusted hazard ratio [adjHR] 2.58; 95% confidence interval [CI] 2.02-3.31; P < 0.001), the gastric banding group (adjHR 1.99; 95%CI 1.41-2.82; P < 0.001), and the vertical banded gastroplasty group (adjHR 2.15; 95% CI 1.66-2.79; P < 0.001). CONCLUSIONS The risk of fracture is increased after gastric bypass surgery. Our findings highlight the need for long-term follow-up of bone health for patients undergoing this treatment.
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Affiliation(s)
- S Ahlin
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Peltonen
- Department of Chronic Disease Prevention, National Institute of Health and Welfare, Helsinki, Finland
| | - K Sjöholm
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Å Anveden
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Halland Hospital, Halmstad, Sweden
| | - P Jacobson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J C Andersson-Assarsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M Taube
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - I Larsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Unit of Clinical Nutrition, Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - L S Lohmander
- Faculty of Medicine, Department of Clinical Sciences Lund, Lund University, Orthopedics, Sweden
| | - I Näslund
- Department of Surgery, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden
| | - P-A Svensson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L M S Carlsson
- From the, Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Saad R, Habli D, El Sabbagh R, Chakhtoura M. Bone Health Following Bariatric Surgery: An Update. J Clin Densitom 2020; 23:165-181. [PMID: 31519474 DOI: 10.1016/j.jocd.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
Abstract
Obesity rates are increasing rapidly, and bariatric surgery is currently the most effective tool for weight loss. Recently, bariatric surgery induced bone loss has gained attention. Such detrimental effect on bone is multifactorial and causes may include nutrient deficiencies, gut and gonadal hormonal changes, mechanical unloading, loss of lean mass, increased bone marrow fat, and increased risk of fall. This review describes the available evidence on bone loss and fracture risk following bariatric surgery and summarizes the guidelines on the topic. Increased bone resorption starts early postsurgery, and bone markers peak at 1-2 yr. Across studies, the drop in areal bone mineral density is inconsistent at the lumbar spine, while a 2%-5% drop at 6 mo and a 6%-10.5% at 9-12 mo are observed at the total hip. Conversely, studies using quantitative CT showed a 6%-7% decrease in volumetric bone mineral density at the lumbar spine at 6-12 mo postsurgery. These studies also report significant bone loss at the radius and tibia, in addition to alteration in bone microarchitecture. Fracture risk increases 2 yr after surgery, more so following malabsorptive procedures. Fractures were reported at axial, weight bearing sites and at appendicular sites. The available evidence is very heterogeneous, and mostly derived from studies on Roux-en-y gastric bypass in premenopausal women. Data on restrictive procedures is scarce. Our findings suggest that the early postoperative phase represents the "golden window" to intervene and promote bone health. More research is needed to determine the effect of different bariatric procedures on bone, to identify optimal interventions to prevent bone loss and to characterize high risk individuals who should be targeted.
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Affiliation(s)
- Randa Saad
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine-American University of Beirut Medical Center, Beirut, Lebanon
| | - Dalal Habli
- Department of Internal Medicine - American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawaa El Sabbagh
- Department of Internal Medicine - American University of Beirut Medical Center, Beirut, Lebanon
| | - Marlene Chakhtoura
- Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, Division of Endocrinology and Metabolism, Department of Internal Medicine-American University of Beirut Medical Center, Beirut, Lebanon.
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Zhang Q, Dong J, Zhou D, Liu F. Comparative risk of fracture for bariatric procedures in patients with obesity: A systematic review and Bayesian network meta-analysis. Int J Surg 2020; 75:13-23. [PMID: 31978646 DOI: 10.1016/j.ijsu.2020.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/08/2020] [Accepted: 01/15/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Bariatric surgery (malabsorptive [i.e., biliopancreatic diversion, BPD], restrictive [i.e., sleeve gastrectomy, SG; adjustable gastric banding, AGB] and mixed [i.e., gastric bypass, GB] procedures) has been reported to be associated with an increased risk of fracture; however, which procedure poses the greatest risk of fracture is still controversial. The aim of the current meta-analysis was to investigate the degree of fracture risk after different bariatric procedures. MATERIAL AND METHODS Electronic databases, including Medline/PubMed, EMBASE and Cochrane library, were systematically searched from inception to July 11, 2019 with no language restrictions to retrieve randomized controlled trials (RCTs) or cohort studies evaluating the impact of any kind of bariatric surgery on postoperative fractures in patients with obesity. Pairwise meta-analysis and Bayesian network meta-analysis were performed to pool the outcome estimates of interest, including fracture incidence and fracture risk. The values of the surface under the cumulative ranking (SUCRA) probability for fracture risk were calculated and sorted according to the different surgical procedures. RESULTS A total of twelve studies published between 2010 and 2019, comprising 159,916 participants with obesity were identified for the analysis. The incidence of fracture increased from 3% (95% confidence interval [CI] 2-4%) in patients with non-surgical intervention (drug treatment, alteration in life style and diet control) to 5% (95% CI 4-7%) in those who had undergone bariatric surgery (pooled relative risk [RR] = 1.41 95% CI: 1.22-1.63). Network meta-analysis revealed that based on the SUCRA ranking of the different surgical procedures, the malabsorptive procedure had the highest possibility of increased fracture risk in patients with obesity (74.75%), followed by the mixed procedures (73.85%), nonsurgical intervention (43.55%) and the restrictive procedure (7.85%); for different surgery types. The BPD group had the highest possibility of increased fracture risk (99.49%), followed by the GB (74.92%), nonsurgical intervention (44.49%), AGB (26.64%) and SG (4.45%) groups. CONCLUSIONS Significant differences exist among different bariatric surgeries impacting on fracture risk. The malabsorptive and mixed procedures, but not the restrictive procedure, increase the postoperative risk of fracture. Considering the weight-reduction effects and fracture risk, the sleeve gastrectomy procedure may be the best choice for patients with obesity, especially those who are susceptible to osteoporosis.
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Affiliation(s)
- Qingyu Zhang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No.324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China.
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Shanker A, Bashashati M. An invited commentary on "Comparative risk of fracture for bariatric procedures in patients with obesity: A systematic review and Bayesian network meta-analysis" [Int. J. Surg. 2020 (75) (13-23)]. Int J Surg 2020; 76:35-36. [PMID: 32084548 DOI: 10.1016/j.ijsu.2020.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Aaron Shanker
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Mohammad Bashashati
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
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50
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Ablett AD, Boyle BR, Avenell A. Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity: Systematic Review and Meta-analysis. Obes Surg 2020; 29:1327-1342. [PMID: 30725431 DOI: 10.1007/s11695-018-03685-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Weight loss interventions for obesity, such as bariatric surgery, are associated with reductions in bone mineral density and may increase the risk of fractures. We undertook a systematic review and meta-analysis of bariatric surgery and lifestyle weight management programs (WMPs) with fracture outcomes. METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials from 1966 to 2018, and our trial registry of WMP randomized controlled trials (RCTs). We included RCTs, non-randomized trials, and observational studies of bariatric surgery, and RCTs of WMPs. Studies had follow-up ≥ 12 months, mean group body mass index ≥ 30 kg/m2. The primary outcome measure was incidence of any type of fracture in participants, and the secondary outcome was weight change. We used random effects meta-analysis for trial data. RESULTS Fifteen studies were included. Three small trials provided short-term evidence of the association between bariatric surgery and participants with any fracture (365 participants; RR 0.82; 95% CI 0.29 to 2.35). Four out of six observational studies of bariatric surgery demonstrated significantly increased fracture risk. Six RCTs of WMPs with 6214 participants, the longest follow-up 11.3 years, showed no clear effect on any type of fracture (RR 1.04; 95% CI 0.91 to 1.18), although authors of the largest RCT reported an increased risk of frailty fracture by their definition (RR 1.40; 95% CI 1.04 to 1.90). CONCLUSION Bariatric surgery appears to increase the risk of any fracture; however, longer-term trial data are needed. The effect of lifestyle WMPs on the risk of any fracture is currently unclear.
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Affiliation(s)
- Andrew D Ablett
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Bonnie R Boyle
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Alison Avenell
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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