Bone Health in Patients with Type 2 Diabetes Treated by Roux-En-Y Gastric Bypass and the Role of Diabetes Remission

Madsen, Lene R.; Espersen, Rasmus; Ørnstrup, Marie Juul; Jørgensen, Niklas Rye; Langdahl, Bente; Richelsen, Bjørn

doi:10.1007/s11695-019-03753-3

Cited by 14 publications

(16 citation statements)

References 36 publications

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“…Clinically significant reduction in bone mineral density (BMD) has been reported in three-fifths of patients at 6 months and in seven-tenths at 12 months after bariatric surgery, alongside a significant association with greater weight loss [18]. Individuals with T2DM treated by gastric bypass, compared to individuals with T2DM of similar age and body composition not treated by gastric bypass, have been reported to have lower BMD, lower bone strength, and increased levels of several bone turnover markers [45]. Another recent study has also reported that levels of bone turnover markers increased significantly after gastric bypass surgery [46].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

et al. 2019

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Background Bariatric surgery for severe obesity can lead to micronutrient/vitamin deficiencies. Aims To study baseline and post-surgical prevalence of vitamin D deficiency in patients undergoing bariatric surgery. Participants and Setting Patients undergoing bariatric surgery in a university teaching hospital in North West England. Methods We performed an observational cohort analysis of longitudinal data on vitamin D and related parameters in patients who underwent bariatric surgery. Patients were routinely recommended daily combined calcium and vitamin D supplementation post-surgery. Results We studied 460 patients who had completed at least 12 months post-operatively; mean (standard deviation) age was 48.0 (10.5) years, weight 144.7 (27.3) kg and body mass index 50.0 (7.6) kg/m 2 ; 292 (63.5%) underwent gastric bypass and 168 (36.5%) sleeve gastrectomy. Vitamin D level was 33.1 (23.9) nmol/L at baseline, rising to 57.1 (23.1) nmol/L at 12 months postsurgery. Whereas 43.2% had vitamin D deficiency and 34.7% insufficiency preoperatively, 8.9% and 26.7% had deficiency and insufficiency, respectively, at 12 months with similar trends up to 4 years of follow-up. There were no significant differences between procedures or sexes in vitamin D levels or sufficiency rates. Conclusion Vitamin D deficiency and insufficiency were prevalent pre-surgery and reduced significantly with routine supplementation post-surgery.

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Section: Discussionmentioning

confidence: 99%

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

et al. 2019

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“…It indicated that there was an exacerbation of bone resorption and bone formation, namely bone transformation was active postoperatively. As several lines of evidence have demonstrated, N-MID and b-CTX were significantly higher after RYGB, along with lower BMD and lower bone strength [29,30]. Notably, in the last few years, accompanied by an explosion of knowledge concerning gut metabolism and adipocytokines, the convergence between bone remodeling and energy metabolism has also been a highlight by means of different gene knockout studies in the mouse [5,31,32].…”

Section: Discussionmentioning

confidence: 99%

Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes

Wang

et al. 2019

Surgery for Obesity and Related Diseases

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Background: Bariatric surgery is an effective and therapeutic way for different metabolic diseases. It has become a focus of attention about the effects and molecular mechanisms to bone metabolism. Objective: We aim to assess the changes of bone mineral density (BMD) among Chinese obese individuals with type 2 diabetes who have undergone Roux-en-Y gastric bypass surgery (RYGB). Two ghrelin gene products, namely unacylated ghrelin (UAG) and obestatin, were evaluated the roles in this pathologic process. Setting: University-affiliated hospital, China. Methods: Thirty patients who had received RYGB were enrolled in the study. Changes in anthropometric parameters, metabolic indexes, and serum UAG and obestatin were assessed preoperatively, 6, 12, and 24 months postoperatively. BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) were identified. Results: RYGB resulted in statistical reductions of BMD in 3 different skeletal parts. After the first 6 months, BMD began to reduce and maintained a declining trend until 24 months postoperatively. Comparing to baseline, the maximal reduction of BMD was as high as 10.28% in total hip. The plasma concentration of UAG increased after 6 months (51.61 6 55.21 versus 71.95 6 64.91 pg/mL; P ,.01), as well as the serum obestatin level (1.65 6 0.88 versus 1.71 6 0.99 ng/mL; P. .05). Although there was a slight drop of both peptides in the first year, they were still above the baseline. Notably, in the second year, UAG and obestatin rose to their peak values, respectively (91.90 6 77.11 pg/mL and 1.74 6 1.09 ng/mL). There was a negative correlation between UAG and BMD in all sites. Multiple linear regression analysis showed that the UAG level was the independent parameter associated with BMD at baseline (FN: b 5-.407, P 5 .012 and TH: b 5-0.396, P 5 .030 respectively), as well as the changes of UAG that were independently related with reduction percentage of LS BMD after 24 months (b 5-.379, P 5.046). Conclusion: The reduction of BMD in obese Chinese with type 2 diabetes was observed after RYGB. The pronounced increase of serum UAG acts as an independent risk factor for the decrease of BMD.

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“…It has been suggested that chronic hyperglycaemia could degrade bone quality through the inhibition of osteocalcin, increased reactive oxygen species, bone accumulation of advanced glycation end products or the inhibition of GLP-1 [40]. In a cross-sectional matched cohort study including individuals with BMI > 35kg/m 2 and T2D (treated by RYGB and non-operated), the authors did not observe a relation between T2D status at the end of the study (remission vs. non-remission) with bone loss [61]. Conversely, in our study, LSBMD at 5 year follow-up correlated positively with HbA 1c values and we found a significantly lower BMD at FN as well as at LS among T2D remitters compared to non-remitters.…”

Section: Discussionmentioning

confidence: 94%

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial

Guerrero-Pérez

Casajoana

Gómez-Vaquero

et al. 2020

JCM

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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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Bone Health in Patients with Type 2 Diabetes Treated by Roux-En-Y Gastric Bypass and the Role of Diabetes Remission

Cited by 14 publications

References 36 publications

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

Vitamin D Status After Gastric Bypass or Sleeve Gastrectomy over 4 Years of Follow-up

Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial

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