Low Bone Mineral Density Following Gastric Bypass is Not Explained by Lifestyle and Lack of Exercise

Overview

Journal BMC Surg

Publisher Biomed Central

Specialty General Surgery

Date 2021 Jun 5

PMID 34088293

Citations 1

Authors

Katharina Stevens

Hella Hultin

Per Hellman

Magnus Sundbom

Affiliations

Soon will be listed here.

Abstract

Background: Bariatric surgery, Roux-en-Y gastric bypass (RYGBP) in particular, is associated with weight loss as well as low bone mineral density. Bone mineral density relies upon multiple factors, some of which are lifestyle factors. The aim of this study was to compare lifestyle factors in order to eliminate them as culprits of the suspected difference in BMD in RYGBP operated and controls.

Materials And Methods: Study participants included 71 RYGBP-operated women (42.3 years, BMI 33.1 kg/m) and 94 controls (32.4 years, BMI 23.9 kg/m). Each completed a DEXA scan, as well as survey of lifestyle factors (e.g. physical activity in daily life, corticosteroid use, and calcium intake). All study participants were premenopausal Caucasian women living in the same area. Blood samples were taken in RYGBP-patients.

Results: BMD was significantly lower in RYGBP, femoral neck 0.98 vs. 1.04 g/cm compared to controls, despite higher BMI (present and at 20 years of age) and similar physical activity and calcium intake. In a multivariate analysis, increased time since surgery and age were negatively associated with BMD of the femoral neck and total hip in RYGBP patients.

Conclusion: Despite similar lifestyle, RYGBP was followed by a lower BMD compared to controls. Thus, the reduced BMD in RYGBP cannot be explained, seemingly nor prevented, by lifestyle factors. As the reduction in BMD was associated with time since surgery, strict follow-up is a lifelong necessity after bariatric surgery, and especially important in younger bariatric patients.

Citing Articles

Association between high-density lipoprotein cholesterol and lumbar bone mineral density in Chinese: a large cross-sectional study.

Sun Y, Qi X, Wang X, Lin X, Zhou Y, Du Y Lipids Health Dis. 2024; 23(1):27.

PMID: 38267987 PMC: 10807139. DOI: 10.1186/s12944-024-02023-1.

References

Liu H, Paige N, Goldzweig C, Wong E, Zhou A, Suttorp M . Screening for osteoporosis in men: a systematic review for an American College of Physicians guideline. Ann Intern Med. 2008; 148(9):685-701. DOI: 10.7326/0003-4819-148-9-200805060-00009. View

Ribom E, Ljunggren O, Mallmin H . Use of a Swedish T-score reference population for women causes a two-fold increase in the amount of postmenopausal Swedish patients that fulfill the WHO criteria for osteoporosis. J Clin Densitom. 2008; 11(3):404-11. DOI: 10.1016/j.jocd.2007.12.014. View

Nordstrom A, Karlsson C, Nyquist F, Olsson T, Nordstrom P, Karlsson M . Bone loss and fracture risk after reduced physical activity. J Bone Miner Res. 2005; 20(2):202-7. DOI: 10.1359/JBMR.041012. View

Livingston E . The incidence of bariatric surgery has plateaued in the U.S. Am J Surg. 2010; 200(3):378-85. PMC: 2923252. DOI: 10.1016/j.amjsurg.2009.11.007. 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

Dimitriadis G, Randeva M, Miras A . Potential Hormone Mechanisms of Bariatric Surgery. Curr Obes Rep. 2017; 6(3):253-265. PMC: 5585994. DOI: 10.1007/s13679-017-0276-5. View

Sanchez-Riera L, Carnahan E, Vos T, Veerman L, Norman R, Lim S . The global burden attributable to low bone mineral density. Ann Rheum Dis. 2014; 73(9):1635-45. DOI: 10.1136/annrheumdis-2013-204320. View

Hage M, El-Hajj Fuleihan G . Bone and mineral metabolism in patients undergoing Roux-en-Y gastric bypass. Osteoporos Int. 2013; 25(2):423-39. DOI: 10.1007/s00198-013-2480-9. View

Pearson O, Lieberman D . The aging of Wolff's "law": ontogeny and responses to mechanical loading in cortical bone. Am J Phys Anthropol. 2004; Suppl 39:63-99. DOI: 10.1002/ajpa.20155. View

10.

Reid R, Carver T, Andersen K, Court O, Andersen R . Physical activity and sedentary behavior in bariatric patients long-term post-surgery. Obes Surg. 2015; 25(6):1073-7. DOI: 10.1007/s11695-015-1624-8. View

11.

Stagi S, Cavalli L, Iurato C, Seminara S, Brandi M, de Martino M . Bone metabolism in children and adolescents: main characteristics of the determinants of peak bone mass. Clin Cases Miner Bone Metab. 2014; 10(3):172-9. PMC: 3917578. View

12.

Frost H . Bone "mass" and the "mechanostat": a proposal. Anat Rec. 1987; 219(1):1-9. DOI: 10.1002/ar.1092190104. View

13.

Heber D, Greenway F, Kaplan L, Livingston E, Salvador J, Still C . Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010; 95(11):4823-43. DOI: 10.1210/jc.2009-2128. View

14.

Henfridsson P, Laurenius A, Wallengren O, Beamish A, Dahlgren J, Flodmark C . Micronutrient intake and biochemistry in adolescents adherent or nonadherent to supplements 5 years after Roux-en-Y gastric bypass surgery. Surg Obes Relat Dis. 2019; 15(9):1494-1502. DOI: 10.1016/j.soard.2019.06.012. View

15.

Angrisani L, Santonicola A, Iovino P, Vitiello A, Higa K, Himpens J . IFSO Worldwide Survey 2016: Primary, Endoluminal, and Revisional Procedures. Obes Surg. 2018; 28(12):3783-3794. DOI: 10.1007/s11695-018-3450-2. View

16.

Laurenius A, Naslund I, Sandvik J, Videhult P, Wiren M . . Lakartidningen. 2018; 115. View

17.

Oldroyd B, Smith A, Truscott J . Cross-calibration of GE/Lunar pencil and fan-beam dual energy densitometers--bone mineral density and body composition studies. Eur J Clin Nutr. 2003; 57(8):977-87. DOI: 10.1038/sj.ejcn.1601633. View

18.

Herring L, Stevinson C, Davies M, Biddle S, Sutton C, Bowrey D . Changes in physical activity behaviour and physical function after bariatric surgery: a systematic review and meta-analysis. Obes Rev. 2016; 17(3):250-61. DOI: 10.1111/obr.12361. View

19.

Smith B, Schauer P, Nguyen N . Surgical approaches to the treatment of obesity: bariatric surgery. Med Clin North Am. 2011; 95(5):1009-30. DOI: 10.1016/j.mcna.2011.06.010. View

20.

Iwaniec U, Turner R . Influence of body weight on bone mass, architecture and turnover. J Endocrinol. 2016; 230(3):R115-30. PMC: 4980254. DOI: 10.1530/JOE-16-0089. View