Changes in Bone Mineral Density After Sleeve Gastrectomy or Gastric Bypass: Relationships with Variations in Vitamin D, Ghrelin, and Adiponectin Levels

Carrasco, Fernando; Basfi-fer, Karen; Rojas, Pamela; Valencia, Alejandra; Csendes, Attila; Codoceo, Juana; Inostroza, Jorge; Ruz, Manuel

doi:10.1007/s11695-014-1179-0

Cited by 94 publications

(76 citation statements)

References 39 publications

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“…Although RYGB and SG are highly effective in causing sustained weight loss, our results add to a body of literature that suggests that bone loss may in fact be the major metabolic complication of such surgeries (2, 4–6, 11–15, 32). In particular, our study shows that RYGB and SG, the two most popular forms of bariatric surgery, are both associated with declines in areal and volumetric BMD at the lumbar spine, and that RYGB is also associated with a decline in total hip areal and volumetric BMD at 12 months.…”

Section: Discussionmentioning

confidence: 50%

“…To date, studies comparing RYGB and SG and their effects on BMD by DXA have shown conflicting results. Two studies of patients undergoing RYGB and SG suggested accelerated bone loss at the lumbar spine and hip after RYGB compared to SG, although the differences were not significant (11, 15), while another study showed no change in lumbar spine BMD but a greater decline in hip BMD following RYGB compared to SG (12). These findings are consistent with our study, which found trends for greater femoral bone loss after RYGB than SG.…”

Section: Discussionmentioning

confidence: 99%

“…Patients typically lose more weight at one year following RYGB compared to patients who undergo SG (9) and data from animal studies suggest that bone loss after RYGB is greater than after SG (10). Only a few studies have compared the effects of RYGB vs SG on bone in humans (11–16), and these have reported conflicting results, with some suggesting that RYGB leads to greater bone loss than SG, whereas others find similar rates of bone loss after both procedures. Of note, all studies used dual-energy x-ray absorptiometry (DXA) to determine bone mineral density (BMD).…”

Section: Introductionmentioning

confidence: 99%

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Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Bredella

Greenblatt

Eajazi

et al. 2017

Bone

146

133

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Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1 ± 5.1 kg/m2) prior to and 12 months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12 months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p<0.04) although the change in femoral vBMD by QCT was not significantly different between groups (p>0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (p<0.04), suggesting that subjects with less weight and VAT loss had higher MAT. In conclusion, RYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with greater decline of aBMD at the total hip and femoral neck compared to SG. MAT content increased after SG and this was associated with lower weight and VAT loss.

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Section: Discussionmentioning

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Bredella

Greenblatt

Eajazi

et al. 2017

Bone

146

133

View full text Add to dashboard Cite

show abstract

“…Adiponectin is involved in energy homeostasis and insulin sensitivity. A literature review shows that adiponectin is almost universally increased after bariatric surgery or medical weight loss (17, 19, 23, 29, 34, 41, 45, 47, 50, 55, 64–84). Moreover, no study showed an increase in adiponectin due to a given procedure not also possibly explained by weight loss.…”

Section: Resultsmentioning

confidence: 99%

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Sweeney

Morton

2014

Best Practice & Research Clinical Gastroenterology

108

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Obesity and type 2 diabetes remain epidemic problems. Different bariatric surgical techniques causes weight loss and diabetes remission to varying degrees. The underlying mechanisms of the beneficial effects of bariatric surgery are complex, and include changes in diet and behavior, as well as changes in hormones, bile acid flow, and gut bacteria. We summarized the effects of multiple different bariatric procedures, and their resulting effects on several hormones (leptin, ghrelin, adiponectin, glucagon-like peptide 1 (GLP-1), peptide YY, and glucagon), bile acid changes in the gut and the serum, and resulting changes to the gut microbiome. As much as possible, we have tried to incorporate multiple studies to try to explain underlying mechanistic changes. What emerges from the data is a picture of clear differences between restrictive and metabolic procedures. The latter, in particular the roux-en-Y gastric bypass, induces large and distinctive changes in most measured fat and gut hormones, including early and sustained increase in GLP-1, possible through intestinal bile acid signaling. The changes in bile flow and the gut microbiome are causally inseparable so far, but new studies show that each contributes to the effects of weight loss and diabetes resolution.

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“…25 Much has been hypothesized about the interplay of adiponectin, vitamin D and PTH in energy and calcium balance, but few direct adiponectin-related mechanisms have been identified. 26, 27 Adiponectin action has been mechanistically tied to another endocrine factor, FGF21, and its co-receptor, beta-klotho in liver and adipose tissue. 28, 29 We therefore hypothesized that a relationship between adiponectin, bone-derived FGF23 and its kidney-based co-receptor alpha-Klotho (here simply referred to as Klotho) exists and may be responsible for the dysregulated calcium and phosphate balance observed under conditions of high adiponectin levels, thereby modulating the cytoprotective effects of Klotho, and contributing to bone disease in CKD.…”

Section: Introductionmentioning

confidence: 99%

Adiponectin alters renal calcium and phosphate excretion through regulation of klotho expression

Rutkowski

Pastor

Sun

et al. 2017

Kidney International

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The kidney controls systemic calcium and phosphate levels and disturbances of its control mechanisms can lead to a variety of diseases. The insulin-sensitizing adipokine adiponectin is renoprotective and accelerates functional recovery following renal injury. However, unlike other adipokines, adiponectin is reduced in obesity. High adiponectin levels are also correlated with bone loss, suggestive of an additional action in mineral metabolism. Using knockout, wildtype, and adiponectin overexpressing transgenic mice, we sought to identify the mechanistic basis for adiponectin’s ability to regulate calcium and phosphate balance at the level of the kidney. Adiponectin knockout mice exhibited lower serum calcium, lower urinary calcium excretion and markedly lower serum fibroblast growth factor 23 (FGF23) levels, although circulating klotho concentrations were significantly higher than in wildtype littermates. The transgenic mice exhibited lower bone mass and strength, particularly compared to adiponectin knockout mice. The transgenic mice were hyper-responsive to 2% phosphate-enriched diet, exhibiting 2-fold higher serum FGF23 and concomitantly higher fractional phosphate excretion. These mice also excreted more calcium with calcium-enriched diet and had less renal klotho protein expression. In contrast, the knockout mice exhibited a smaller increase in FGF23 and maintained elevated klotho levels on both mineral challenges. Kidney-specific adiponectin expression in doxycycline-inducible adiponectin mice and adiponectin addition in vitro confirmed adiponectin’s ability to reduce tubular epithelial cell klotho secretion. Thus, adiponectin alters calcium and phosphate balance and renal mineral excretion, in part, through klotho. This work highlights the profound effects of adipose tissue on renal function and has identified a new mechanism by which adiponectin may regulate bone mass.

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Changes in Bone Mineral Density After Sleeve Gastrectomy or Gastric Bypass: Relationships with Variations in Vitamin D, Ghrelin, and Adiponectin Levels

Abstract: One year after gastric bypass, bone mineral density was significantly affected, mainly at the femoral neck. Decreases in bone mineral density were more dramatic among patients who had greater baseline BMD and greater reduction in ghrelin concentrations.

Cited by 94 publications

References 39 publications

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Metabolic surgery: Action via hormonal milieu changes, changes in bile acids or gut microbiota? A summary of the literature

Adiponectin alters renal calcium and phosphate excretion through regulation of klotho expression

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