Exercise Mitigates Bone Loss in Women With Severe Obesity After Roux-en-Y Gastric Bypass: A Randomized Controlled Trial

Abstract

Context Bone loss after bariatric surgery potentially could be mitigated by exercise. Objective To investigate the role of exercise training (ET) in attenuating bariatric surgery–induced bone loss. Design Randomized, controlled trial. Setting Referral center for bariatric surgery. Patients Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB). Intervention Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only). Outcomes Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes. Results Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), −2.91%; P = 0.007;], total hip (EMD, −2.26%; P = 0.009), distal radius (EMD, −1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, −2.09%; P = 0.024). Exercise also attenuated CTX (EMD, −0.20 ng/mL; P = 0.002), P1NP (EMD, −17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, −610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium). Conclusion Exercise mitigated bariatric surgery–induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.

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

“…A recent randomized controlled trial evaluated whether bone loss after RYGB could be prevented or decreased by resistance training. Although the study had small patient numbers and a short follow-up of 6 months, the authors showed that compared with RYGB alone (n 5 25), patients undergoing resistance exercise training (n 5 24) were able to mitigate the percent loss of BMD, measured using QCT as the estimated mean difference (EMD) of the femoral neck (EMD, 22.91%; P 5 .007), total hip (EMD, 22.26%; P 5 .009), and distal radius (EMD, 21.87%; P 5 .038), with attenuation of several bone turnover markers [30]. In addition, changes in gut hormones that are produced in fat tissue, such as adipokines, leptin, and adiponectin, are reduced after RYGB, while there are increases in other gut hormones, like PYY, glucagon-like peptide-1, and ghrelin, which has been shown in vitro to increase osteoclastic cell proliferation, although this finding has not been confirmed in patients using BMD and DXA [28,31].…”

Obesity and Bone

“…Weight-bearing exercise increases bone density 7 , so pressure from excessive weight may strengthen bone 8 . Consistent with this, significant weight loss achieved with bariatric surgery results in bone loss 9 , which can be mitigated by exercise 10 . However, despite more bone mass, obesity confers an increased risk of osteoporosis 11 and bone fractures 12 , at least in some sites.…”

Bone Density and Trabecular Morphology at Least 10 Years After Gastric Bypass and Gastric Banding

“…Several studies have suggested that supervised exercise programs can partially mitigate bone loss after RYGB. ( 49,50 ) It remains unknown whether other bone‐modifying treatments can fully prevent RYGB‐induced high‐turnover bone loss.…”