Parathyroid Hormone and Bone Marker Levels in Patients with Morbid Obesity Before and After Biliopancreatic Diversion

Abstract

In obese patients, we found no correlation between iPTH levels and BMI. Supplements of calcium and vitamin D did not prevent the appearance of SHP following BPD. The patients with high pre-surgery iPTH levels have a higher risk of malabsorption of calcium and vitamin D. Following malabsorptive bariatric surgery, there is an increase in bone resorption, which results in DPD and CTx increase. Those markers do not correlate with iPTH, and this may suggest that there is a phenomenon of bone reshaping parallel to the loss of weight.

Bone Metabolism Changes after Laparoscopic Greater Curvature Plication. A One-Year Study.

“…According to the literature, the level of PTH in the blood after bariatric surgery can change in the direction of its decrease or increase [25][26][27]. In our study, we note a signifi cant decrease in PTH levels starting from the 3rd month of observation, which is in weak negative correlation with VTD, BMI and FAT.…”

Bariatric surgery and bone metabolism: a systematic review

“…Moreiro and cols. (14) evaluated the occurrence of secondary hyperparathyroidism (SHPT), the relationship between serum PTH and BMI and the effect of biliopancreatic diversion surgery (BPD) on serum PTH, urinary deoxypyridinoline (DPD)/creatinine ratio and serum CTX in 96 morbid obese patients. The patients' ages ranged from 19 to 60 years, (23 men and 73 women) with an initial mean BMI of 53 kg/m 2 , who were compared with 77 non-obese controls (67 women and 10 men).…”

“…The prevalence of hyperparathyroidism may reach 58% in patients after RYBG (14)(15)18). Furthermore, patients submitted to bariatric surgery may present chronic magnesium depletions which also leads to a blunt in PTH secretion, osteoporosis and vitamin D deficiency (20).…”

“…Bone resorption occurs very soon after surgery with increased levels of urinary NTx (18), CTX (14) and DPD (14,17) at three months and serum osteocalcin at 12 months (18). It is worth mentioning, however, that according to some studies the bone mass of obese patients, even after loss following surgery, still remains greater than in non-obese individuals (39).…”

Clinical application of laparoscopic bariatric surgery: an evidence-based review

“…Supplements do not prevent the development of secondary hyperparathyroidism. An increase in bone resorption is known to occur irrespective of parathormone levels, suggesting a phenomenon of bone reshaping parallel to the loss of weight [154]. Because of fat malabsorption resulting from BPD, supplementation of fat-soluble vitamins is recommended.…”