Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with                     Obesity Assessed with Quantitative CT and MR Spectroscopy

Huber, Florian A.; Singhal, Vibha; Tuli, Shubhangi; Becetti, Imen; López, Alba Nogueira; Bouxsein, Mary L.; Misra, Madhusmita; Bredella, Miriam A.

doi:10.1148/radiol.223256

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…Trabecular bone occupies most of the skeletal area within the vertebra. While no difference in DXA LS BMD between surgical vs. control groups was noted in our cohort, Huber et al reported declines in LS trabecular vBMD and vertebral body strength using quantitative CT at 24 months following adolescent VSG compared to non-surgical controls ( 40 ). This finding may explain the adjusted relative risk of 1.70 for clinical spine fractures following MBS in adults compared to non-obese controls ( 18 ).…”

Section: Discussioncontrasting

confidence: 76%

Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers

Wasserman,

Jenkins,

Inge

et al. 2023

Preprint

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Objective Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort.Methods Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison.Results Compared to controls, adjusted mean DXA-BMD of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and − 6.3%), femoral neck (-9.6% and − 5.7%) and ultra-distal radius (-7.9% and − 7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and − 26%) and VSG (-15% and − 14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MSB were not associated with bone measures at a median of 9.3 years post MSB.Conclusion BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck decreased with time since MBS but were not associated with BMI change.

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Section: Discussioncontrasting

confidence: 76%

Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers

Wasserman,

Jenkins,

Inge

et al. 2023

Preprint

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“…There is strong in vitro evidence that adipocytes support the long-term survival of hematopoietic lineage cells via kit signaling [36] and a recent study concluded that lipolysis from BMAT is required to fuel bone cells and the marrow niche following energy deficits or injury [21]. However, weight loss due to a chronic energy deficit has highly variable effects on BMAT levels in humans as well as experimental animals [37,38]. Decreased weight due to involuntary caloric restriction often, but not always, leads to an increase in BMAT [37,39].…”

Section: Discussionmentioning

confidence: 99%

Bone Marrow Adipose Tissue Is Not Required for Reconstitution of the Immune System Following Irradiation in Male Mice

Keune,

Wong,

Branscum

et al. 2024

IJMS

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Bone marrow adipose tissue (BMAT) is hypothesized to serve as an expandable/contractible fat depot which functions, in part, to minimize energy requirements for sustaining optimal hematopoiesis. We investigated whether BMAT is required for immune reconstitution following injury. Male wild type (WBB6F1, WT) and BMAT-deficient WBB6F1/J-KitW/KitW-v/J (KitW/W-v) mice were lethally irradiated. Irradiation was followed by adoptive transfer of 1000 purified WT hematopoietic stem cells (HSCs). The extent of immune reconstitution in blood, bone marrow, and lymph nodes in the irradiated mice was determined using HSCs from green fluorescent protein (GFP)-expressing mice. We also evaluated skeletal response to treatment. Detection of GFP-positive B and T cells in peripheral blood at 4 and 9 weeks following adoptive transfer and in bone marrow and lymph nodes following necropsy revealed excellent immune reconstitution in both WT and BMAT-deficient mice. Adipocytes were numerous in the distal femur of WT mice but absent or rare in KitW/W-v mice. Bone parameters, including length, mass, density, bone volume, microarchitecture, and turnover balance, exhibited few differences between WT and BMAT-deficient mice. The minimal differences suggest that BMAT is not required for reconstitution of the immune system following lethal radiation and is not a major contributor to the skeletal phenotypes of kit signaling-deficient mice.

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“…After surgical weight loss, changes in BMAT are equivocal, depending on age, sex, menopausal status, measurement site, diabetes status, and type of surgery [52][53][54][55][56][57][58][59]. Under these conditions, it is difficult to interpret potential links between changes in BMAT and bone parameters, and even more difficult to discuss the local or systemic factors involved.…”

Section: Discussionmentioning

confidence: 99%

“…It appears that the increase in lumbar BMAT after SG consists of both saturated and unsaturated BMAT, while the decrease in femoral and tibial BMAT after SG is primarily related to a decrease in saturated BMAT. Huber et al [57] reported 2-year follow-up data on vertebral BMD and BMAT in 54 adolescents (52 subjects' baseline data were reported by Bredella et al [56]), out of which 25 underwent sleeve SG and 29 subjects in a control group (dietary and exercise counselling). This first study to report a follow-up at 2 years, showed an increase in vertebral BMAT and a decrease in vertebral trabecular vBMD, similar to their results after the 1-year follow-up.…”

Section: Sleeve Gastrectomymentioning

confidence: 99%

The Impact of Interventional Weight Loss on Bone Marrow Adipose Tissue in People Living with Obesity and Its Connection to Bone Metabolism

Tencerova,

Duque,

Beekman

et al. 2023

Nutrients

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This review focuses on providing physicians with insights into the complex relationship between bone marrow adipose tissue (BMAT) and bone health, in the context of weight loss through caloric restriction or metabolic and bariatric surgery (MBS), in people living with obesity (PwO). We summarize the complex relationship between BMAT and bone health, provide an overview of noninvasive imaging techniques to quantify human BMAT, and discuss clinical studies measuring BMAT in PwO before and after weight loss. The relationship between BMAT and bone is subject to variations based on factors such as age, sex, menopausal status, skeletal sites, nutritional status, and metabolic conditions. The Bone Marrow Adiposity Society (BMAS) recommends standardizing imaging protocols to increase comparability across studies and sites, they have identified both water–fat imaging (WFI) and spectroscopy (1H-MRS) as accepted standards for in vivo quantification of BMAT. Clinical studies measuring BMAT in PwO are limited and have shown contradictory results. However, BMAT tends to be higher in patients with the highest visceral adiposity, and inverse associations between BMAT and bone mineral density (BMD) have been consistently found in PwO. Furthermore, BMAT levels tend to decrease after caloric restriction-induced weight loss. Although weight loss was associated with overall fat loss, a reduction in BMAT did not always follow the changes in fat volume in other tissues. The effects of MBS on BMAT are not consistent among the studies, which is at least partly related to the differences in the study population, skeletal site, and duration of the follow-up. Overall, gastric bypass appears to decrease BMAT, particularly in patients with diabetes and postmenopausal women, whereas sleeve gastrectomy appears to increase BMAT. More research is necessary to evaluate changes in BMAT and its connection to bone metabolism, either in PwO or in cases of weight loss through caloric restriction or MBS, to better understand the role of BMAT in this context and determine the local or systemic factors involved.

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Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy

Cited by 8 publications

References 28 publications

Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers

Bone mineral density 5 to 11 years after metabolic and bariatric surgery in adolescents with severe obesity compared to peers

Bone Marrow Adipose Tissue Is Not Required for Reconstitution of the Immune System Following Irradiation in Male Mice

The Impact of Interventional Weight Loss on Bone Marrow Adipose Tissue in People Living with Obesity and Its Connection to Bone Metabolism

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