Bariatric Surgery Results in Cortical Bone Loss

Stein, Emily; Carrelli, Angela L.; Young, Polly; Bucovsky, Mariana; Zhang, Chiyuan; Schrope, Beth; Bessler, Marc; Zhou, Bin; Ji, Wang; Guo, X. Edward; McMahon, Donald J.; Silverberg, Shonni J.

doi:10.1210/jc.2012-2394

Cited by 130 publications

(170 citation statements)

References 41 publications

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“…In the present study, median serum 25(OH)D in BS group was low and not different from Cont before surgery, which agrees well with other reports (9,12). Whereas hypovitaminosis D in class II and III obese patients more often occurs because of the sequestration of vitamin D in adipose tissue (16), the reasons in BS patients include not only pre-operative low levels of 25(OH)D (15), but also low compliance with oral supplements (17).…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, urinary DPYD was also higher in BS patients than in Cont, indicating an increased bone resorption, as detected by other investigators (20,21), even when using different bone resorption markers as well (8,20,22,23). Therefore, an increased bone turnover has been clearly evidenced by the present findings, which corroborates with numerous reports (8,12,13,15,24), although not with all of them (9,21).…”

Section: Discussionsupporting

confidence: 91%

“…(15) and with other investigators, who employed different biochemical markers of bone formation (8,12). Moreover, urinary DPYD was also higher in BS patients than in Cont, indicating an increased bone resorption, as detected by other investigators (20,21), even when using different bone resorption markers as well (8,20,22,23).…”

Section: Discussionsupporting

confidence: 60%

“…Of note, we found a positive correlation of serum BAP with time after surgery. A substantial increase in bone formation and resorption markers had occurred up to 24 months after gastric bypass despite weight stability, as described by many authors (12,13,29), reinforcing that bone remodeling remains elevated despite weight loss plateaus after the first year and are not exclusively due to mechanical unloading of the skeleton.…”

Section: Discussionsupporting

confidence: 52%

“…Previous studies that evaluated skeletal changes after bariatric surgery through dual-energy x-ray absorptiometry (DXA), quantitative computed tomography (QCT) and high-resolution peripheral computed tomography (HR-pQCT) demonstrated a decreased BMD and also increased bone turnover markers (7,9,(12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Bone turnover after bariatric surgery

Melo

Froeder

Baia

et al. 2017

Arch. Endocrinol. Metab.

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Objective: The aim of the present study was to evaluate parameters of bone and mineral metabolism after bariatric surgery. Subjects and methods: This sectional study included data from medical records from 61 bariatric surgery (BS) patients (minimum period of 6 months after the procedure) and from 30 class II and III obese patients as a control group (Cont), consisting of daily dietary intake of macronutrients, calcium and sodium, serum 25(OH)D and parathyroid hormone (PTH) and other biochemical serum and urinary parameters. Bone alkaline phosphatase (BAP), leptin, fibroblast growth factor-23 (FGF-23) and deoxypyridinoline (DPYD) were determined from available banked serum and urinary samples. Results: Mean body mass index (BMI), median energy, carbohydrate, protein and sodium chloride consumption were significantly lower in the BS versus Cont, but calcium and lipids were not. No significant differences were found in ionized calcium, 25(OH)D, PTH and fibroblast growth factor 23 (FGF-23) between groups. Mean serum BAP was significantly higher for BS versus Cont and had a positive correlation with time after the surgical procedure. Mean serum leptin was significantly lower and median urinary DPYD higher in BS versus Cont. Conclusion: The present study showed an increase in bone markers of both bone formation and resorption among bariatric patients up to more than 7 years after the surgical procedure, suggesting that an increased bone turnover persists even at a very long-term follow-up in such patients. Arch Endocrinol Metab.2017;61(3):332-6.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 60%

Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Bone turnover after bariatric surgery

Melo

Froeder

Baia

et al. 2017

Arch. Endocrinol. Metab.

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Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity

et al. 2020

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IMPORTANCE Given the complex relationship between body mass index, body composition, and bone density and the correlative nature of the studies that have established the prevailing notion that higher body mass indices may be protective against osteopenia and osteoporosis and, therefore, fracture, the absolute risk of fracture in patients with severe obesity who undergo either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) compared with those who do not undergo bariatric surgery is unknown. OBJECTIVE To assess the rates of fractures associated with obesity and compare rates between those who do not undergo bariatric surgery, those who undergo RYGB, and those who undergo SG. DESIGN, SETTING, AND PARTICIPANTS In this retrospective multicenter cohort study of Medicare Standard Analytic Files derived from Medicare parts A and B records from January 2004 to December 2014, patients classified as eligible for bariatric surgery using the US Centers of Medicare & Medicaid criteria who either did not undergo bariatric surgery or underwent RYGB or SG were exactly matched in a 1:1 fashion based on their age, sex, Elixhauser Comorbidity Index, hypertension, smoking status, nonalcoholic fatty liver disease, hyperlipidemia, type 2 diabetes, osteoporosis, osteoarthritis, and obstructive sleep apnea status. Data were analyzed from November to December 2019. EXPOSURES RYGB or SG. MAIN OUTCOMES AND MEASURES The primary outcome measured in this study was the odds of fracture overall based on exposure to bariatric surgery. Secondary outcomes included the odds of type of fracture (humerus, radius or ulna, pelvis, hip, vertebrae, and total fractures) based on exposure to bariatric surgery. RESULTS A total of 49 113 patients were included and were equally made up of 16 371 bariatric surgery-eligible patients who did not undergo weight loss surgery, 16 371 patients who had undergone RYGB, and 16 371 patients who had undergone SG. Each group consisted of an equal number of 4109 men (25.1%) and 12 262 women (74.9%) and had an equal distribution of ages, with 11 780 patients (72.0%) 64 years or younger, 4230 (25.8%) aged 65 to 69 years, 346 (2.1%) aged 70 to 74 years, and 15 (0.1%) aged 75 to 79 years. Patients undergoing RYGB were found to have no significant difference in odds of fractures compared with bariatric surgery-eligible patients who did not undergo surgery. Patients undergoing undergone SG were found to have decreased odds of fractures of the humerus (odds ratio [OR], 0.57; 95% CI, 0.45-0.73), radius or ulna (OR, 0.38; 95% CI, 0.25-0.58), hip (OR, 0.49; 95% CI, 0.33-0.74), pelvis (OR, 0.34; 95% CI, 0.18-0.64), vertebrae (OR, 0.60; 95% CI, 0.48-0.74), or fractures in general (OR, 0.53; 95% CI, 0.46-0.62). Compared with patients undergoing SG, patients undergoing RYGB had a significantly greater risk of total fractures (OR, 1.79; 95% CI, 1.55-2.06) and humeral fractures (OR, 1.60; 95% CI, 1.24-2.07).

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Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries

Kim

Sturgeon

et al. 2019

JAMA Surg

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IMPORTANCE Roux-en-Y gastric bypass (RYGB) is associated with significant bone loss and may increase fracture risk, whereas substantial bone loss and increased fracture risk have not been reported after adjustable gastric banding (AGB). Previous studies have had little representation of patients aged 65 years or older, and it is currently unknown how age modifies fracture risk.OBJECTIVE To compare fracture risk after RYGB and AGB procedures in a large, nationally representative cohort enriched for older adults.

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Bariatric Surgery Results in Cortical Bone Loss

Abstract: After bariatric surgery, hip bone loss reflects skeletal unloading and cortical bone loss reflects secondary hyperparathyroidism. This study highlights deterioration of cortical bone loss as a novel mechanism for bone loss after bariatric surgery.

Cited by 130 publications

References 41 publications

Bone turnover after bariatric surgery

Bone turnover after bariatric surgery

Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity

Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries

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