Alterations of bone markers in obese patients with type 2 diabetes after bariatric surgery

Abstract

Background: The aim of this study is to evaluate the alterations in bone mineral density and other surrogate markers for osteoporosis in obese patients with type 2 diabetes mellitus (T2DM) who received Roux-en-Y gastric bypass (RYGB) versus medical treatment as control. Methods: We searched 4 electronic databases and reference lists of relevant studies for eligible research published before December, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including lumbar spine bone mineral density (L-spine BMD) change, total hip BMD change, osteocalcin level, C-terminal telopeptide level, and parathyroid hormone level. Results: Three randomized clinical trials and 2 observational studies concerning 307 total obese T2DM patients were included. Follow-up ranged from 12 to 60 months. Patients underwent RYGB surgery were associated with both higher L-spine BMD loss (mean difference: −2.90, 95% CI: −2.99∼−2.81, P < .00001) and total hip BMD loss (mean difference: −5.81, 95% CI: −9.22∼−2.40, P = .0008). As to biochemical markers of bone metabolism, we found significantly higher osteocalcin level in medical treatment (control) group compared with RYGB group (mean difference: 11.16, 95% CI: 8.57–13.75, P < .00001). However, higher C-terminal telopeptide level and parathyroid hormone level were noted in medical treatment group (control) compared with RYGB group (mean difference: 0.29, 95% CI: 0.11–0.48, P = .002; mean difference: 1.56, 95% CI: 0.84–2.27, P < .0001). Conclusions: RYGB surgery is associated with negative impact on bone metabolism and increase the risk of osteoporosis in obese patients with T2DM. We suggest that clinicians acknowledge the adverse effects of surgery and keep monitoring bone mineral components in post-RYGB populations. Further studies regarding the optimal amount of perioperative and postsurgical supplementation should be evaluated.

Osteodietology

“…Kanno et al, demonstrated that naringin inhibited the LPS-induced production of NO and the expression of inflammatory gene products such as TNF-a, IL-6, iNOS, COX-2 and the transcriptional activity of NF-kB. Suppression of these pro-inflammatory cytokines which are the positive regulators of osteoclastogenesis via the inhibition of NF-kB might result in the inhibition of osteoclastogenesis and bone resorption (123). Further, naringin promoted angiogenesis and neovascularization during fracture callus formation in murine osteoporotic models, likely by regulating the expression of VEGF in osteocytes (119).…”

“…Figure 2 summarizes visually the changes occurring over time in bone turnover markers after bariatric surgery. Interestingly, the magnitude of variation in bone turnover markers is reportedly similar between diabetic and non-diabetic cohorts undergoing bariatric surgery, yet patients T2DM patients carry per se a higher risk of osteoporosis (122,123). Because alterations in CTX and P1NP levels have also been reported in adolescents after RYGB (124) and SG (125), uncertainties remain on the final effect of bariatric surgery on bone mass peak and subsequent adult risk of osteoporosis.…”

“…Similarly, extracts from Brassicaceae induced bone formation in control rats (54) and prevented bone loss in several models of osteoporosis (59,99,(106)(107)(108). Interestingly, treatment with Lepidium sativum resulted in improved fracture healing (28,123).…”

Effect of calcium plus Vitamin-D combined with calcitriol in the treatment of patients with Type-2 diabetes and osteoporosis: A retrospective observational analysis

“…Effect of calcium plus Vitamin-D combined with calcitriol in the treatment of patients with Type-2 diabetes and osteoporosis: A retrospective observational analysis control, calcium and Vitamin-D supplementation, and exercise therapy. [5][6][7] For severe osteoporosis, medication such as bisphosphate can be considered. 7,8 Calcium plus Vitamin-D supplements increase calcium and Vitamin-D3 levels, thus promoting bone formation and increasing bone density.…”

“…The current treatment methods for T2DM combined with osteoporosis mainly include blood glucose control, calcium and Vitamin-D supplementation, and exercise therapy. 5 - 7 For severe osteoporosis, medication such as bisphosphate can be considered. 7 , 8 Calcium plus Vitamin-D supplements increase calcium and Vitamin-D3 levels, thus promoting bone formation and increasing bone density.…”