Changes in Bone Metabolism After Sleeve Gastrectomy Versus Gastric Bypass: a Meta-Analysis

Abstract

Background Gastric bypass (GB) and sleeve gastrectomy (SG) are two common types of bariatric surgery that carry many potential complications. Among these complications, bone metabolism-related diseases have attracted substantial attention; however, no meta-analysis of them has been performed to date. Methods We searched PubMed, Web of Science, The Cochrane Library, and Embase to identify relevant studies published before January 2019. The following indicators were evaluated: serum parathyroid hormone (PTH), calcium, phosphorus and 25hydroxyvitamin D levels, body mass index (BMI), and bone mineral density (BMD). Results Thirteen studies met our inclusion criteria. Overall results showed that patients undergoing GB had lower levels of 25hydroxyvitamin D (MD = − 1.85, 95% CI (− 3.32, − 0.39) P = 0.01) and calcium (MD = − 0.15, 95% CI (− 0.24, − 0.07) P = 0.0006) as well as higher levels of PTH (MD = 3.58, 95% CI (0.61, 7.09) P = 0.02) and phosphorus (MD = 0.22, 95% CI (0.10, 0.35) P = 0.0005). The results of BMI and BMD were comparable in each group. Conclusion Our meta-analysis suggested that obese patients undergoing GB had lower levels of serum calcium and 25hydroxyvitamin D as well as higher levels of serum phosphorus and PTH. To prevent postoperative bone metabolism-related diseases, appropriate postoperative interventions should be undertaken for particular surgical procedures.

Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement

“…Other authors have also reported similar BMD loss among RYGB and SG groups [20,41], including a recent meta-analysis by Tian et al [42] 22; 95% CI, .10-.35; P 5 .0005), the body mass index (BMI) changes and BMD by DXA (femoral neck, lumbar spine, total hip, or total body) were comparable in both groups at 1 year. In contrast, Hsin et al [43] conducted a 1-year observational study comparing RYGB, SG, and LAGB in patients and performed baseline and 1-year DXA scans.…”

Risedronate to Prevent Bone Loss After Sleeve Gastrectomy: Study Design and Feasibility Report of a Pilot Randomized Controlled Trial

“…(32,33) In the past decade, however, over a dozen studies have reported on longitudinal changes in BMD following SG, with losses of 3% to 7% in the 6 to 12 months following surgery noted, particularly at the axial skeleton. (2,3) The magnitude of bone loss does appear to be less with SG than with RYGB; although losses are still considered clinically meaningful. (3,33) Data reporting on fracture risk specific to SG are more limited.…”

“…As of 2018, approximately 252,000 bariatric surgeries were performed in the United States, with the increasingly popular sleeve gastrectomy (SG) procedure comprising 61% of all surgical types. ( 1 ) Prospective data consistently report hip BMD losses of 3% to 7% in the 6 to 12 months following SG ( 2,3 ) —similar to other bariatric procedures ( 4 ) — that appear to persist after the cessation of weight loss. ( 5 ) Data also link mixed bariatric surgical procedures with reductions in bone quality, ( 6,7 ) although less is known about SG, specifically.…”

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

“…There is a lack of studies comparing long-term BMD outcomes after different surgical procedures. In a meta-analysis, comparing BMD changes after RYGB and SG, bone outcomes were similar [48]. However, in only one of 13 studies included, the follow-up time was greater than 2 years.…”