High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures

Wei, Jih Hua; Lee, Wei Jei; Chong, Keong; Lee, Yi Chih; Chen, Shu Chun; Huang, Po Hsun; Lin, Shing Jong

doi:10.1007/s11695-017-2932-y

Cited by 100 publications

(85 citation statements)

References 41 publications

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“…Long-term studies focusing on fracture risk and changes in bone mineral density are needed to further explore this. High prevalence of secondary hyperparathyroidism after RYGB, and even higher after malabsorptive procedures, has been reported [24,30,31]. In our study, only BALP was increased in patients with secondary hyperparathyroidism compared with patients with normal PTH at 2 years, while multivariate analysis also showed correlation with PINP.…”

Section: Comparison With Other Reportssupporting

confidence: 61%

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial

et al. 2019

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Background Roux-en-Y gastric bypass is associated with increased risk of bone fractures. Malabsorptive procedures may be associated with secondary hyperparathyroidism and detrimental effects on bone health. We aimed to compare the effects of standard and distal gastric bypass on bone turnover markers 2 years after surgery. Methods Patients with body mass index (BMI) 50-60 kg/m 2 (n = 113) were randomized to standard or distal gastric bypass, 105 patients (95%) completed 2-year follow-up. Serum C-terminal telopeptide of type I collagen (CTX-1), procollagen type I Npropeptide (PINP), and bone-derived alkaline phosphatase (BALP) was measured at baseline and up to 2 years after surgery. ANCOVA and linear mixed models were used to compare groups. Results The levels of bone turnover markers increased significantly in both groups, with no statistically significant difference between groups. Two years after standard and distal gastric bypass mean (SD) CTX-1 were 0.81 (0.32) and 0.83 (0.31) μg/L (p = 0.38), mean PINP was 77.6 (23.2) and 77.7 (29.3) μg/L (p = 0.42), and BALP 47.9 (21.9) vs. 50.7 (19.6) μg/L (p = 0.38), respectively. Multiple linear regression analyses showed that PINP and BALP correlated positively (p = 0.01 and p < 0.001) with PTH, but only BALP was significantly higher in patients with secondary hyperparathyroidism (p = 0.001). Type of surgery, vitamin D serum concentrations, and 2-year BMI were all independently associated with PTH levels.

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Section: Comparison With Other Reportssupporting

confidence: 61%

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial

et al. 2019

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“…Eight of thirteen included studies reported the serum calcium level of postoperative patients undergoing SG or GB. Except for two studies [35,36], the remaining six showed similar calcium levels between patients after SG and GB [24,26,29,30,32,34]. In our overall analysis, we found that patients Fig.…”

Section: Discussionmentioning

confidence: 61%

“…Two reviewers then excluded 238 articles after screening titles and abstracts independently, and 41 articles were assessed for eligibility. Ultimately, 13 studies [24][25][26][27][28][29][30][31][32][33][34][35][36] were selected for inclusion.…”

Section: Literature Searchmentioning

confidence: 99%

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

Tian

Fan

et al. 2019

OBES SURG

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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.

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“…Thus, vitamin D deficiency to the extent that will drive an increase in bone turnover or decrease bone mineral density is clinically relevant. The prevalence of secondary hyperparathyroidism (sHPT) related to vitamin D deficiency in obesity was reported to be over 20% (169,178) and increased up to 71% depending on vitamin D status (171), while the threshold for parathyroid stimulation can be widely variable (179,180). In addition to disturbances in the vitamin D -calcium homeostasis, obesity may involve other mechanisms affecting PTH regulation that are incompletely understood.…”

Section: Reasoningmentioning

confidence: 99%

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

Pasquali

Casanueva

Haluzı́k

et al. 2020

European Journal of Endocrinology

135

156

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Obesity is an emerging condition, with a prevalence of ~20%. Although the simple measurement of BMI is likely a simplistic approach to obesity, BMI is easily calculated, and there are currently no data showing that more sophisticated methods are more useful to guide the endocrine work-up in obesity. An increased BMI leads to a number of hormonal changes. Additionally, concomitant hormonal diseases can be present in obesity and have to be properly diagnosed – which in turn might be more difficult due to alterations caused by body fatness itself. The present European Society of Endocrinology Clinical Guideline on the Endocrine Work-up in Obesity acknowledges the increased prevalence of many endocrine conditions in obesity. It is recommended to test all patients with obesity for thyroid function, given the high prevalence of hypothyroidism in obesity. For hypercortisolism, male hypogonadism and female gonadal dysfunction, hormonal testing is only recommended if case of clinical suspicion of an underlying endocrine disorder. The guideline underlines that weight loss in obesity should be emphasized as key to restoration of hormonal imbalances and that treatment and that the effect of treating endocrine disorders on weight loss is only modest.

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High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures

Cited by 100 publications

References 41 publications

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial

Bone Turnover Markers After Standard and Distal Roux-en-Y Gastric Bypass: Results from a Randomized Controlled Trial

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

European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity

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