Alterações de parâmetros relacionados ao metabolismo ósseo em mulheres submetidas à derivação gástrica em Y de Roux

Abstract

RESUMOObjetivo: Avaliar o metabolismo ósseo e a densidade mineral óssea (DMO) em mulheres adultas pós-derivação gástrica em Y de Roux (DGYR). Sujeitos e métodos: Estudo transversal com 48 mulheres submetidas a DGYR há três anos e 41 saudáveis. Dados obtidos: índice de massa corporal (IMC), atividade física, consumo alimentar e DMO da coluna lombar, colo e fêmur total. Dosagem de cálcio, fósforo, magnésio, albumina, fosfatase alcalina, telopeptídeo-C (CTX), paratormônio (PTH), 25-hidroxivitamina D (25OHD), osteocalcina e cálcio urinário. Resultados: Maiores alterações no grupo DGYR observadas nos níveis de osteocalcina (p < 0,001), CTX (p < 0,001) e PTH (p < 0,001). Deficiência de 25OHD foi a mais frequente no grupo DGYR (p = 0,010). Deficiência/insuficiência de 25OHD associou-se com hiperparatiroidismo secundário (p = 0,025). Não houve diferença entre os grupos em relação à DMO. A ingestão de energia (p = 0,036) e proteína (p = 0,004) foi maior no grupo controle. Conclusão: Em mulheres pós-DGYR, encontraram-se alta frequência de deficiência de vitamina D, hiperparatireoidismo secundário e elevação nos marcadores de remodelação óssea, sem alteração na DMO quando comparado com o grupo controle não obeso. Arq Bras Endocrinol Metab. 2012;56(6):376-82 Descritores Cirurgia bariátrica; densidade mineral óssea; vitamina D; hiperparatiroidismo secundário; anastomose em-Y de Roux ABSTRACT Objective: To evaluate bone turnover markers and bone mineral density (BMD) in women after Roux-en-Y (RYGB) gastric bypass. Subjects and methods: In a cross-sectional study, 48 women post-RYGB after three years, and 41 healthy women were evaluated. Evaluations: body mass index (BMI); physical activity; food intake; serum levels of calcium, phosphorus, magnesium, alkaline phosphatase, C-terminal telopeptide (CTX), intact parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), osteocalcin, urinary calcium and BMD. Results: Significantly higher levels were observed for osteocalcin (p < 0.001), CTX (p < 0.001), and PTH (p < 0.001) in the RYGB group when compared with the control group; 25OHD deficiency/insufficiency was more frequent in the RYGB group (p = 0.010), even after adjusted for nutritional status, and it was associated with secondary hyperparathyroidism (p = 0.025); there was no difference in BMD between the groups. Energy (p = 0.036) and protein intake (p = 0.004) were lower in the RYGB group. Conclusion: Patients submitted to RYGB showed a significantly higher frequency of vitamin D deficiency, secondary hyperparathyroidism, and increase in bone remodeling markers, with no difference in BMD status. Arq Bras Endocrinol Metab. 2012;56(6):376-82

Nutrient Deficiency 10 Years Following Roux-en-Y Gastric Bypass: Who’s Responsible?

“…This finding is consistent with increased rates of bone loss following RYGB however we are unaware of prospective studies examining supplementation after RYGB[24]. We did not perform assessments of bone mineral density in the current study via DEXA, but our findings are consistent with Santos et al[26]. Thus, additional work is warranted in patients to understand the effect of calcium supplementation on preservation of bone mineral density to prevent osteoporosis and bone disorders.…”

Anthropometric measurements, deficiency of vitamin d and calcium in patients in pre- and post-operative bariatric surgery

“…This is possibly justified by the poor functional and mobility capacity that morbidly obese patients experience with weight gain 25,26 . On the other hand, there is evidence that in the postoperative period (2-6 years) only 4% of the individuals did not perform any type of regular physical exercise 27 , suggesting that the weight loss can motivate practice of physical activity but it can also be a facilitator of the limitations of these patients in relation to mobility.…”

Secondary Hyperparathyroidism After Bariatric Surgery: Treatment Is With Calcium Carbonate or Calcium Citrate?

“…Supplementation is recommended in the immediate postoperative period to prevent the progressive loss of bone mass 15 , 16 . Many patients do not adhere to regular supplement use.…”