A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures

Hsin, Ming-Che; Huang, Chih‐Kun; Tai, Chi‐Ming; Yeh, Lee‐Ren; Kuo, Hsin-Chih; Garg, Amit

doi:10.1016/j.soard.2014.07.008

Cited by 50 publications

(34 citation statements)

References 27 publications

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“…The mechanisms behind the increased risk of fracture after gastric bypass are not fully elucidated. The increased risk of osteoporotic fracture after gastric bypass in our study suggests that weakening of the bone may play a role, supported by studies demonstrating that gastric bypass is associated with reduction in bone mineral density . It has been suggested that mechanical unloading due to weight loss is a driver of bone loss after bariatric surgery .…”

Section: Discussionsupporting

confidence: 75%

“…In the present study, we also show that treatment with gastric banding is associated with a moderately increased risk of osteoporosis fracture and that treatment with vertical banded gastroplasty is associated with a moderately increased risk of any fracture. A reduction of bone mineral density has been observed also after these procedures, but not to the same magnitude as for gastric bypass . In addition, sensitivity analysis indicates that our findings regarding fracture risks after gastric banding and vertical banded gastroplasty could be affected by unmeasured confounding.…”

Section: Discussionmentioning

confidence: 68%

“…Several studies have shown a reduction in bone mineral density after bariatric surgery and retrospective studies indicate that bariatric surgery is associated with increased fracture risk . However, a small randomized trial found no increased fracture risk for patients receiving bariatric surgery and a recent meta‐analysis on fracture risk after bariatric surgery called for additional high‐quality, prospective studies that investigate fracture risk after bariatric surgery .…”

Section: Introductionmentioning

confidence: 99%

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Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study

et al. 2020

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Ahlin S, Peltonen M, Sj€ oholm K, Anveden A, Jacobson P, Andersson-Assarsson JC, Taube M, Larsson I, Lohmander LS, N€ aslund I, Svensson P-A, Carlsson LMS ). Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow-up of a controlled intervention study. J Intern Med 2020; 287: 546-557.Background. Previous studies have reported an increased fracture risk after bariatric surgery.Objective. To investigate the association between different bariatric surgery procedures and fracture risk.Methods. Incidence rates and hazard ratios for fracture events were analysed in the Swedish Obese Subjects study; an ongoing, nonrandomized, prospective, controlled intervention study. Hazard ratios were adjusted for risk factors for osteoporosis and year of inclusion. Information on fracture events were captured from the Swedish National Patient Register. The current analysis includes 2007 patients treated with bariatric surgery (13.3% gastric bypass, 18.7% gastric banding, and 68.0% vertical banded gastroplasty) and 2040 control patients with obesity matched on group level based on 18 variables. Median follow-up was between 15.1 and 17.9 years for the different treatment groups.Results. Duringfollow-up,the highestincidence ratefor first-time fracture was observed in the gastric bypass group (22.9 per 1000 person-years). The corresponding incidence rates were 10.4, 10.7 and 9.3 per 1000 person-years for the vertical banded gastroplasty, gastric banding and control groups, respectively. The risk of fracture was increased in the gastric bypass group compared with the control group (adjusted hazard ratio [adjHR] 2.58; 95% confidence interval [CI] 2.02-3.31; P < 0.001), the gastric banding group (adjHR 1.99; 95%CI 1.41-2.82; P < 0.001), and the vertical banded gastroplasty group (adjHR 2.15; 95% CI 1.66-2.79; P < 0.001).Conclusions. The risk of fracture is increased after gastric bypass surgery. Our findings highlight the need for long-term follow-up of bone health for patients undergoing this treatment.Fracture and bariatric surgery / S. Ahlin et al.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

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Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study

et al. 2020

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“…To date, studies comparing RYGB and SG and their effects on BMD by DXA have shown conflicting results. Two studies of patients undergoing RYGB and SG suggested accelerated bone loss at the lumbar spine and hip after RYGB compared to SG, although the differences were not significant (11, 15), while another study showed no change in lumbar spine BMD but a greater decline in hip BMD following RYGB compared to SG (12). These findings are consistent with our study, which found trends for greater femoral bone loss after RYGB than SG.…”

Section: Discussionmentioning

confidence: 99%

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Bredella

Greenblatt

Eajazi

et al. 2017

Bone

142

133

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Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1 ± 5.1 kg/m2) prior to and 12 months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12 months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p<0.04) although the change in femoral vBMD by QCT was not significantly different between groups (p>0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (p<0.04), suggesting that subjects with less weight and VAT loss had higher MAT. In conclusion, RYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with greater decline of aBMD at the total hip and femoral neck compared to SG. MAT content increased after SG and this was associated with lower weight and VAT loss.

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“…Changes in bone microarchitecture, including reduced trabecular number suggest an accompanying reduction in bone strength (Frederiksen, et al 2016). The reduction in BMD and strength may not be entirely due to weight loss and the magnitude of change varies with the surgical procedure (Hsin, et al 2015). In this regard, bariatric surgery can negatively impact bone health due to impaired absorption of critical micronutrients and alterations in bone regulating hormones (Yu 2014).…”

Section: Weight Lossmentioning

confidence: 99%

Influence of body weight on bone mass, architecture and turnover

Iwaniec

Turner

2016

Journal of Endocrinology

138

108

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Weight-dependent loading of the skeleton plays an important role in establishing and maintaining bone mass and strength. This review focuses on mechanical signaling induced by body weight as an essential mechanism for maintaining bone health. In addition, the skeletal effects of deviation from normal weight are discussed. The magnitude of mechanical strain experienced by bone during normal activities is remarkably similar among vertebrates, regardless of size, supporting the existence of a conserved regulatory mechanism, or mechanostat, that senses mechanical strain. The mechanostat functions as an adaptive mechanism to optimize bone mass and architecture based on prevailing mechanical strain. Changes in weight, due to altered mass, weightlessness (spaceflight), and hypergravity (modeled by centrifugation), induce an adaptive skeletal response. However, the precise mechanisms governing the skeletal response are incompletely understood. Furthermore, establishing whether the adaptive response maintains the mechanical competence of the skeleton has proven difficult, necessitating development of surrogate measures of bone quality. The mechanostat is influenced by regulatory inputs to facilitate non-mechanical functions of the skeleton, such as mineral homeostasis, as well as hormones and energy/nutrient availability that support bone metabolism. While the skeleton is very capable of adapting to changes in weight, the mechanostat has limits. At the limits, extreme deviations from normal weight and body composition are associated with impaired optimization of bone strength to prevailing body size.

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A case-matched study of the differences in bone mineral density 1 year after 3 different bariatric procedures

Cited by 50 publications

References 27 publications

Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study

Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Influence of body weight on bone mass, architecture and turnover

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