The Endocrine Society's Clinical Practice Guideline on endocrine and nutritional management of the post-bariatric surgery patient: Commentary from a European Perspective

Torres, Antonio; Rubio, Miguel A.

doi:10.1530/eje-11-0357

Cited by 22 publications

(11 citation statements)

References 40 publications

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“…Vitamin D depletion has been frequently associated with worse physical performance, increased risk of falls, and impaired muscle strength, particularly in the elderly [72–81]. While muscle weakness and pain represent the typical pattern of osteomalacic-associated muscle disease, even atypical clinical presentations are frequent.…”

Section: Vitamin D and Skeletal Musclementioning

confidence: 99%

Vitamin D and Its Relationship with Obesity and Muscle

Cipriani

Pepe

Piemonte

et al. 2014

International Journal of Endocrinology

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The skin synthesis of vitamin D represents the first step of a metabolic pathway whose features have been extensively studied and clarified in the last decades. In particular, the production of active and inactive forms of the hormone and the actions of the corresponding enzymes have offered new insights into the knowledge of vitamin D metabolism. Additionally, the description of the different organs and tissues expressing the vitamin D receptor and its possible functions, as well as its genetic determinants, have allowed focusing on the interrelationship between vitamin D and many physiological and pathological functions. In this context, many studies reported the association between vitamin D and adipose tissue metabolism, as well as the possible role of the hormone in obesity, weight, and fat mass distribution. Finally, many reports focused on the vitamin D-related effects on skeletal muscle, particularly on the mechanisms by which vitamin D could directly affect muscle mass and strength. This paper is mainly aimed to review vitamin D metabolism and its relationship with obesity and skeletal muscle function.

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Section: Vitamin D and Skeletal Musclementioning

confidence: 99%

Vitamin D and Its Relationship with Obesity and Muscle

Cipriani

Pepe

Piemonte

et al. 2014

International Journal of Endocrinology

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“…Clinical guidelines regarding bone health among patients undergoing bariatric surgery focus primarily on endocrine and nutritional management before and after gastric bypass procedures [108][109][110][111][112]. In the absence of normative QCT data or other accessible imaging techniques, the recommended preoperative DXA scans to identify patients with, or at risk of, low bone mass, and to establish a baseline areal BMD to be reassessed annually until stable [109,112], may be of limited value given the variability of DXA areal BMD measurements in obese populations, particularly during weight loss [47][48][49]96,97]. However, recommendations to assess bone in patients 2 years postoperatively, forgoing preoperative DXA scanning [108], when weight loss has stabilized, will probably provide more accurate DXA bone measurements with greater clinical usefulness.…”

Section: Clinical Considerationsmentioning

confidence: 99%

Skeletal effects of bariatric surgery: examining bone loss, potential mechanisms and clinical relevance

Scibora

2014

Diabetes Obesity Metabolism

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Bariatric surgery is the most effective therapeutic approach to morbid obesity, resulting in substantial weight loss and improved cardiometabolic profiles; however, a growing body of evidence suggests that bariatric procedures increase both skeletal fragility and the risk of related future fracture secondary to excessive bone loss. Prospective evidence shows that areal bone mineral density (BMD) assessed by dual energy X-ray absorptiometry (DXA) declines by as much as 14% in the proximal femoral regions, including the femoral neck and total hip, 12 months postoperatively. Lumbar spine areal BMD outcomes show greater 12-month postoperative variability across surgical procedures (-8 to +6%) and contrast with no change in volumetric BMD outcomes measured by quantitative computed tomography. Diminished mechanical loading, micronutrient deficiency and malabsorption, along with neurohormonal alterations, offer plausible underlying mechanisms to explain these observed post-bariatric bone changes, but most remain largely unsubstantiated in this population. Importantly, DXA-based skeletal imaging may have limited utility in accurately detecting bone change in people undergoing bariatric surgery; partly because excessive tissue overlying bone increases the variability of areal BMD outcomes. Moreover, a paucity of fracture and osteoporosis incidence data raises questions about whether marked post-bariatric surgery bone loss is clinically relevant or a functional adaptation to skeletal unloading. Future studies that use technology which is able to accurately capture the site-specific volumetric BMD and bone architectural changes that underpin bone strength in people undergoing bariatric surgery, that consider mechanical load, and that better quantify long-term fracture and osteoporosis incidence are necessary to understand the actual skeletal effects of bariatric surgery.

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“…Negative calcium balance and vitamin D deficiency predispose to osteoporosis and osteomalacia following gastric bypass. Guidelines recommend monitoring for calcium, phosphorous, vitamin D, PTH, and alkaline phosphatase levels every six months, along with an annual bone densitometry, until adequate control is ensured [2,32]. Patients should be maintained on 1000-1200 mg calcium and 600-800 units of vitamin D daily, after correction of deficiency.…”

Section: Discussionmentioning

confidence: 99%

“…Several reviews and guidelines emphasize the importance of screening for overweight and obesity disorders [1][2][3][4][5][6][7]. Recently, the Obesity Society, in collaboration with the American College of Cardiology/American Heart Association (ACC/AHA), has issued a guideline on the management of overweight and obesity disorders and provided suggestions to better address overweight or obese patients [1].…”

Section: Introductionmentioning

confidence: 99%