Bone loss after bariatric surgery: causes, consequences, and management

Abstract

Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many co-morbidities. Among the side effects of these procedures are detrimental effects on bone and mineral metabolism. This review explores the skeletal response to bariatric surgery, potential mechanisms for these changes and strategies for management. Bone disease among bariatric surgery patients is influenced by pre-operative abnormalities in bone and mineral metabolism related to morbid obesity. Changes that occur after surgery are specific to procedure type, with the most pronounced abnormalities in calciotropic hormones and bone loss seen after procedures that result in the most malabsorption. The most consistent site for bone loss after all bariatric procedures is at the hip, although available BMD data are limited by issues associated with DXA technology, including artifact introduced by adipose tissue itself. The bone loss that occurs after bariatric surgery is likely multifactorial. Proposed mechanisms include skeletal unloading, abnormalities in calciotropic hormones, as well as changes in gut hormones. There are very limited data on fracture risk in the bariatric population, and this is a critical area for additional research. Current treatment should be geared toward correcting nutritional deficiencies and following BMD in high-risk patients.

Vitamin D alteration associated with obesity and bariatric surgery

“…50,51 The limitations of the studies in terms of interpretation of data are linked most often to the weakness of samples of patients, the lack of consistency of the measurements made, out of study patients substantial rates, especially as soon as the track exceeds one year. The heterogeneity of patients studied in terms of age, gender, ethnic group, and surgical techniques is also a source of limits.…”

“…Finally, in many studies, calcium and vitamin D supplementation is part of the routine clinical care and is often subject to ancillary study to the main study protocol, thus persistence and adherence to treatment with vitamin D are not evaluated. 51 The type of bariatric surgery will influence the degree of weight loss, calorific deficit, and malabsorption. Thus, in the procedure known as RYGB, the longer the intestinal loop, known as the Roux loop, the shorter the common circuit, (i.e.…”

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

“…The three most commonly performed bariatric surgeries are Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (gastric banding), and sleeve gastrectomy [50]. In RYGB, the stomach is stapled to create a small pouch, which reduces the amount of food that can be consumed.…”

“…In RYGB, the stomach is stapled to create a small pouch, which reduces the amount of food that can be consumed. This small pouch is then directly attached to the small intestine, which effectively bypasses the rest of the stomach and the upper part of the small intestine, thus considerably reducing the surface area available for absorption of nutrients [50]. Patients undergoing RYGB typically lose 35% of their initial bodyweight, which corresponds to a loss of 62%-75% of excess body weight [51].…”

Bone Metabolism Changes after Laparoscopic Greater Curvature Plication. A One-Year Study.

“…It belongs to the «safe organ preserving surgery», has a high effi ciency rate and is commonly chosen for treating extreme cases of obesity. However, issues with changes in bone metabolism have recently been brought to light in association to bariatric surgery [6][7][8][9].…”