Objective To determine the 2 yr outcomes of RYGB, sleeve gastrectomy (SG) vs. intensive medical therapy (IMT) on lean body mass, total bone mass and BMD measures from the STAMPEDE trial. Methods 54 subjects (BMI: 36±1 kg/m2, age: 48±4y) with T2DM (HbA1c: 9.7±2%) were randomized to IMT, RYGB, or SG and underwent DXA at baseline, 1 and 2 yrs. Results At 2 yr, the reduction in BMI was similar after RYGB and SG, and was greater than IMT (P<0.001). Lean mass was reduced by ~10%, total bone mineral content reduced by ~8% and hip BMD reduced by ~9% in both surgical groups, and was significantly greater than IMT despite increases in vitamin D intake in all groups. The change in hip BMD correlated with weight loss (r = 0.84, P<0.0001), and changes in lean mass (r = 0.74, P<0.0001), and leptin (r = 0.53, P<0.0001). Peripheral fractures were self-reported in RYGB (4/18 patients), SG (2/19 patients) and the IMT (4/16 patients). Conclusion Surgically induced weight loss is associated with modest reductions in lean mass, bone mineral content and density, despite calcium and vitamin D supplementation in patients with T2DM. Awareness for bone loss is indicated for patients undergoing bariatric procedures.

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