Metabolic Bone Disease After Intestinal Bypass for Treatment of Obesity

Am, Parfitt; Mj, Miller; Ar, Villanueva; Ds, Rao; Oliver, I.T.; Dl, Thomson

doi:10.7326/0003-4819-89-2-193

Cited by 100 publications

(28 citation statements)

References 21 publications

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“…The decrease in bone mass may arise from insufficient bone matrix synthesis due to the combination of hypoproteinemia secondary to impairment of nitrogen absorption and osteoblastic dysfunction [6,8,10], as well as negative calcium balance [8,14]. As reported by many investigators [3,[5][6][7][8][9]11], vitamin D metabolism was impaired in beagles haying undergone the intestinal resection in the present study. Although no change occurred in serum levels of calcium, phosphorus, and protein in these beagles, digestion and absorption were apparently affected.…”

Section: Discussionsupporting

confidence: 64%

“…If 25 (OH) D level falls further, however, this mechanism will fail to compensate the fall, and result in a fall of 1,25(OH)~D. Bone mineral content measured by single photon absorptiometry showed 10~ or a little more several years after the operation [3][4][5]14]. However, osteopenia solely due to resection of the intestine has never been so severe to cause pathologic fracture.…”

Section: Discussionmentioning

confidence: 99%

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The effect of massive intestinal resection on the dog skeleton

et al. 1994

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.4 bstract :In order to explain a risk factor for osteoporosis, effects of chronic malabsorption on bone mass were experimentally assessed. In beagles, the distal three quarters of the small intestine was resected, and effects of the deficit on bone mass was studied. After double tetracycline labelling each dog was sacrificed, and sections of undecalcified lumbar vertebra were prepared for bone morphometry. Effects of postoperative treatment with ursodesoxycholic acid(UDCA) and l a (OH)D3 or with la (OH)D3 alone were also evaluated. The massive resection of the distal small intestine resulted in a decrease of serum lipid level and apparent malabsorption, leading to prominent changes in metabolism of vitamin D such as decreased production of 25(OH)D and 24,25(OH)2D. Six months after the resection, neither a decrease in bone mass nor impaired calcification could be documented in agreement with the lasting normal 1,25(OH)2D level. Decreases in osteoid volume and thickness, as well as low bone formation rates, suggested insufficient bone matrix synthesis presumably associated with malabsorption. Consequently, bone mass would eventually decrease after massive intestinal resection. UDCA and vit.D3 supplements produced no clear effect on the bone.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

The effect of massive intestinal resection on the dog skeleton

et al. 1994

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“…1 Although a number of small studies have previously indicated that osteoporosis may also occur after jejunoileal bypass, 19 ± 21 most reviewers of the literature have emphasised the clinical effects of osteomalacia and secondary hyperparathyroidism. 21 This is certainly the case for the patients in this study who have been recruited from a meticulously studied cohort followed for over 20 y. In this group, Osteoporosis and obesity surgery G Bano et al osteomalacia was unrelated to age, length of time since bypass or to post-bypass weight loss.…”

Section: Discussionmentioning

confidence: 99%

“…Bone resorption indices were not increased at the time of biopsy. The conclusion, when the data were ®rst reported in 1978, 21 was that this signi®cant bone loss (after intestinal shunt surgery) results from the combined effects of an unsustained increase in bone resorption (osteoclast-mediated and accounting for two-thirds of the effect) and a sustained decrease in bone formation (osteoblast-mediated and accounting for one-third of the effect). After reinterpretation of some of the assumptions made in the analysis of this data, they were republished in 1991 23 with the conclusion that the main effect is due to alterations in osteoblast function.…”

Section: Discussionmentioning

confidence: 99%

Reduced bone mineral density after surgical treatment for obesity

et al. 1999

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OBJECTIVE: To investigate whether osteoporosis occurs after surgical treatment for obesity. DESIGN: A cross-sectional study of ®ve groups of subjects who had undergone surgical treatment for obesity: ®ve premenopausal women; 13 post-menopausal women; seven post-menopausal women taking oestrogen replacement (HRT); ®ve men; and six women who had undergone surgical reversal (mean time 7 y). SUBJECTS: Thirty-six Caucasian subjects who had undergone jejunoileal or pancreaticobiliary bypass surgery at St George's Hospital between 1971 and 1992. Their mean age was 50.8 y (range 32 ± 69 y) and the median time since the operation was 14.8 y (range 4 ± 23 y). MEASUREMENTS: A clinical questionnaire was used to exclude possible factors, which might in¯uence bone mineral density. A single blood sample was collected for measurement of calcium, phosphate, alkaline phosphatase, albumin, magnesium, zinc, creatinine, thyroxine, 25-hydroxy-vitamin D, sex steroids, gonadotrophins and IGF-1 and 24 h urine calcium excretion was measured. Bone mineral density (BMD) was measured in the lumbar (L2-L4) spine (LS) and femoral neck (FN) by dual energy X-ray absorptiometry (DEXA). RESULTS: There was no difference in serum calcium, alkaline phosphatase, IGF-1, 25-hydroxy-vitamin D (25-OH vitamin D), magnesium or zinc concentrations between the ®ve groups. The LS-BMD T score was lower (P`0.05) in male subjects ( 7 2.08 AE 1.04 mean 1.0 AE s.d) and post-menopausal women not taking HRT ( 7 1.21 AE 1.33) compared to the surgically reversed group (0.87 AE 2.36). The male group was most severely affected, despite normal serum testosterone concentrations. Two of the ®ve men studied, had a LS-BMD T score`7 2.5 and two had a LS-BMD T score between 7 1.0 and 7 2.5. In contrast, six of the seven post-menopausal women on HRT had an LS BMD T score b 7 1.0. There was no difference in the FN-BMD between the ®ve groups. The presence of low BMD was not related to age, duration of bypass, or degree of postoperative weight loss. Iliac crest bone biopsies in three subjects with low BMD, con®rmed the presence of osteoporosis. CONCLUSIONS: Reduced bone mineral density is a complication of jejunoileal bypass surgery.

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“…L'analyse de ce cadre 6tiologique est difficile. Les pathologies impliqu6es sont multiples : la gastrectomie, les r6sec-tions intestinales, les ent6rocolopathies inflammatoires, les syndromes de malabsorption, les cirrhoses alcooliques ou non, les pancr6atites chroniques, les transplantations h6pa-tiques [12,46,50]. Les d6terminants physiopathog6niques sont nombreux et souvent associ6s chez un m~me patient : carence calcique ou vitaminique D, carences prot6iques, consommation d'alcool ou de tabac, traitement par les glucocortico]'des, prise r6p6t6e d'antiacides (qui provoquent une hypophosphor6mie).…”

Section: E) Les Maladies H~patodigestivesunclassified

Stéroides sexuels et ostéoporose chez l'homme

Legrand

Simon

Audran

2002

Androl.

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Service de Rhumatologie. CHU d'Angers, 49033 ANGERS Cedex. RI~SUMI~Les 6tudes 6pidemiologiques r6centes ont confirm6 que rost6oporose 6tait fr6quente chez rhomme. Apr~s 50 ans, 18% des hommes seront victimes d'au moins une fracture ost6oporotique et 6 ~ 8 % auront une fracture de I'extr6mit6 sup6rieure du fdmur. Dans 60% des cas environ la perte osseuse est secondaire ~ des facteurs 6tiologiques intriqu6s : corticoth(~rapie prolong6e, hypogonadisme franc, intoxication tabagique ou alcoolique, maladie digestive ou h6patique chronique. L'ost6oporose masculine primitive ou idiopathique, qui repr6sente environ 40% des patients, touche souvent des hommes jeunes, entre 40 et 60 ans, indemnes de toute autre pathologie. Plusieurs voies pathog6-niques sont actuellement explor6s pour comprendre les raisons de cette perte osseuse chez ces patients : les facteurs g6n6tiques, un eventuel d6fi-cit cellulaire de la formation osseuse mais surtout le r61e des st6roides sexuels biodisponibles. La carence en androgenes s'accompagne d'une acc6-16ration du remodelage osseux au profit de la rdsorption et d'une perte osseuse franche, pr6do-minant dans le secteur trab6culaire. En fait I'action des androg6nes sur le tissu osseux est double : directe, en raison d'un r61e stimulant de la testost6-rone sur la formation osseuse mais surtout indirecte par I'interm6diaire de I'estradiol, produit par aromatisation de la testost6rone, qui rdgule le remodelage osseux et freine la r6sortpion osseuse. Finallement la densit6 osseuse et le risque de fracture sont mieux corr616s avec les taux s6riques d'estradiol biodisponible et de Sex Hormone Binding Globulin (SHBG) qu'avec le taux plasmatique de testost6rone, chez les hommes ~g6s de plus de 60 ans.

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Metabolic Bone Disease After Intestinal Bypass for Treatment of Obesity

Cited by 100 publications

References 21 publications

The effect of massive intestinal resection on the dog skeleton

The effect of massive intestinal resection on the dog skeleton

Reduced bone mineral density after surgical treatment for obesity

Stéroides sexuels et ostéoporose chez l'homme

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