Changes in Bone Mineral Density in Women Following 1-year Gastric Bypass Surgery

Overview

Journal Obes Surg

Date 2012 Jun 14

PMID 22692668

Citations 42

Authors

Daniela Schaan Casagrande

Giuseppe Repetto

Claudio Cora Mottin

Jatin Shah

Ricardo Pietrobon

Mathias Worni

Beatriz D Schaan

Affiliations

Soon will be listed here.

Abstract

Background: Roux-en-Y gastric bypass (RYGB) surgery is the gold standard surgical treatment for obesity. However, unintended nutritional deficiencies following this surgery are common, including changes in bone metabolism. We assessed changes in bone mineral density (BMD), nutritional compounds, and bone resorption markers before and 1 year following RYGB surgery.

Methods: Our study included 22 female patients with class II/III obesity. A clinical questionnaire, a 24-h recall, blood and urine samples, and dual-energy X-ray absorptiometry were provided.

Results: Mean age was 37.2 ± 9.6 years; 86 % were Caucasian and 77.2 % were premenopausal. Mean preoperative body mass index was 44.4 ± 5.0 and 27.5 ± 4.5 kg/m(2) at 1-year follow-up (p < 0.001). 25-OH-vitamin D-levels were similar in both periods [11.7 (9.7-18.0) vs. 15.7 (10.2-2.7) pg/dL, p = 0.327]. Serum N-telopeptide (16.3 ± 3.4 vs. 38.2 ± 7.0 nM BCE, p < 0.001) and parathyroid hormone (45.4 ± 16.7 vs. 62.7 ± 28.9 pg/mL, p = 0.026) increased after RYGB surgery, reflecting bone resorption. BMD decreased after RYGB surgery in the lumbar spine (1.13 ± 0.11 vs. 1.04 ± 0.09 g/cm(2), p = 0.001), femoral neck (1.03 ± 0.15 vs. 0.94 ± 0.16 g/cm(2), p = 0.001), and total femur (1.07 ± 0.11 vs. 0.97 ± 0.15 g/cm(2), p = 0.003).

Conclusions: Decreased BMD in the lumbar spine, femoral neck, and total femur is detectable in women 1 year after RYGB surgery. Calcium malabsorption, caused by vitamin D deficiency and increased bone resorption, is partially responsible for these outcomes and should be targeted in future clinical trials.

Citing Articles

Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers.

Wasserman H, Jenkins T, Inge T, Ryder J, Michalsky M, Sisley S Int J Obes (Lond). 2024; 48(4):575-583.

PMID: 38177697 DOI: 10.1038/s41366-023-01453-8.

Bone Densitometry and Fat Index after Sleeve and Subsleeve Gastrectomy in Animal Model.

Khazraei H, Hosseini S, Amini M, Amirzadeh S, Dehghanian A, Sobhani Z Adv Biomed Res. 2022; 11:48.

PMID: 35982864 PMC: 9379916. DOI: 10.4103/abr.abr_124_20.

Changes in the Bone Mineral Density after Sleeve Gastrectomy vs. Roux-En-Y Gastric Bypass 2 Years after Surgery.

Castro M, Jimenez J, Lopez M, Cao M, Gonzalez-Ramirez G, Bolanos-Munoz M Nutrients. 2022; 14(15).

PMID: 35893910 PMC: 9329775. DOI: 10.3390/nu14153056.

Bone Response to Weight Loss Following Bariatric Surgery.

Mele C, Caputo M, Ferrero A, Daffara T, Cavigiolo B, Spadaccini D Front Endocrinol (Lausanne). 2022; 13:921353.

PMID: 35873004 PMC: 9301317. DOI: 10.3389/fendo.2022.921353.

Low bone mineral density following gastric bypass is not explained by lifestyle and lack of exercise.

Stevens K, Hultin H, Hellman P, Sundbom M BMC Surg. 2021; 21(1):282.

PMID: 34088293 PMC: 8178896. DOI: 10.1186/s12893-021-01281-5.

References

Baim S, Binkley N, Bilezikian J, Kendler D, Hans D, Lewiecki E . Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom. 2008; 11(1):75-91. DOI: 10.1016/j.jocd.2007.12.007. View

Higa K, Ho T, Tercero F, Yunus T, Boone K . Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011; 7(4):516-25. DOI: 10.1016/j.soard.2010.10.019. View

Silva B, Camargos B, Fujii J, Dias E, Soares M . [Prevalence of vitamin D deficiency and its correlation with PTH, biochemical bone turnover markers and bone mineral density, among patients from ambulatories]. Arq Bras Endocrinol Metabol. 2008; 52(3):482-8. DOI: 10.1590/s0004-27302008000300008. View

Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T . Biochemical markers of bone turnover as predictors of osteoporosis and osteoporotic fractures in men and women: 10-year follow-up of the Taiji cohort. Mod Rheumatol. 2011; 21(6):608-20. DOI: 10.1007/s10165-011-0455-2. View

Valderas J, Velasco S, Solari S, Liberona Y, Viviani P, Maiz A . Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass. Obes Surg. 2009; 19(8):1132-8. DOI: 10.1007/s11695-009-9890-y. View

Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R . Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)-a prospective study. Obes Surg. 2010; 20(4):447-53. DOI: 10.1007/s11695-009-0068-4. View

Ricci T, Heymsfield S, Pierson Jr R, Stahl T, Chowdhury H, Shapses S . Moderate energy restriction increases bone resorption in obese postmenopausal women. Am J Clin Nutr. 2001; 73(2):347-52. DOI: 10.1093/ajcn/73.2.347. View

Luporini Saraiva G, Cendoroglo M, Ramos L, Araujo L, Vieira J, Kunii I . Influence of ultraviolet radiation on the production of 25 hydroxyvitamin D in the elderly population in the city of São Paulo (23 degrees 34'S), Brazil. Osteoporos Int. 2005; 16(12):1649-54. DOI: 10.1007/s00198-005-1895-3. View

Vilarrasa N, Gomez J, Elio I, Gomez-Vaquero C, Masdevall C, Pujol J . Evaluation of bone disease in morbidly obese women after gastric bypass and risk factors implicated in bone loss. Obes Surg. 2009; 19(7):860-6. DOI: 10.1007/s11695-009-9843-5. View

10.

Whitehead C, Fleming R . Osteoporosis in cage layers. Poult Sci. 2000; 79(7):1033-41. DOI: 10.1093/ps/79.7.1033. View

11.

Colossi F, Casagrande D, Chatkin R, Moretto M, Barhouch A, Repetto G . Need for multivitamin use in the postoperative period of gastric bypass. Obes Surg. 2007; 18(2):187-91. DOI: 10.1007/s11695-007-9384-8. View

12.

Duran de Campos C, Dalcanale L, Pajecki D, Garrido Jr A, Halpern A . Calcium intake and metabolic bone disease after eight years of Roux-en-Y gastric bypass. Obes Surg. 2008; 18(4):386-90. DOI: 10.1007/s11695-007-9393-7. View

13.

Flegal K, Carroll M, Ogden C, Curtin L . Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010; 303(3):235-41. DOI: 10.1001/jama.2009.2014. View

14.

Garcia O, Long K, Rosado J . Impact of micronutrient deficiencies on obesity. Nutr Rev. 2009; 67(10):559-72. DOI: 10.1111/j.1753-4887.2009.00228.x. View

15.

Colquitt J, Picot J, Loveman E, Clegg A . Surgery for obesity. Cochrane Database Syst Rev. 2009; (2):CD003641. DOI: 10.1002/14651858.CD003641.pub3. View

16.

Aills L, Blankenship J, Buffington C, Furtado M, Parrott J . ASMBS Allied Health Nutritional Guidelines for the Surgical Weight Loss Patient. Surg Obes Relat Dis. 2008; 4(5 Suppl):S73-108. DOI: 10.1016/j.soard.2008.03.002. View

17.

Sinha N, Shieh A, Stein E, Strain G, Schulman A, Pomp A . Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery. Obesity (Silver Spring). 2011; 19(12):2388-93. PMC: 3411200. DOI: 10.1038/oby.2011.133. View

18.

Vilarrasa N, San Jose P, Garcia I, Gomez-Vaquero C, Miras P, de Gordejuela A . Evaluation of bone mineral density loss in morbidly obese women after gastric bypass: 3-year follow-up. Obes Surg. 2010; 21(4):465-72. DOI: 10.1007/s11695-010-0338-1. View

19.

Rokholm B, Baker J, Sorensen T . The levelling off of the obesity epidemic since the year 1999--a review of evidence and perspectives. Obes Rev. 2010; 11(12):835-46. DOI: 10.1111/j.1467-789X.2010.00810.x. View

20.

Mahdy T, Atia S, Farid M, Adulatif A . Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: Mansoura experiences. Obes Surg. 2008; 18(12):1526-31. DOI: 10.1007/s11695-008-9653-1. View