Bariatric surgery and bone disease: from clinical perspective to molecular insights

Folli, Franco; Sabowitz, Brian; Schwesinger, Wayne H.; Fanti, Paolo; Guardado-Mendoza, Rodolfo; Muscogiuri, Giovanna

doi:10.1038/ijo.2012.115

Cited by 79 publications

(64 citation statements)

References 118 publications

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“…These include alterations in hypothalamic neuropeptide expression in response to energy deficit, notably an increase in that of neuropeptide Y [23], alterations in circulating concentrations of gut-derived appetite-regulating hormones, notably peptide YY and GLP-1 [10,11], reductions in active levels of other hormones such as sex hormones and insulin-like growth factor [110], and -in the bariatric population -changes in vitamin D and parathyroid hormone status (not strongly supported by the literature) or adipokines [33,111]. These potential pathways are not discussed in detail here, because they are not as readily amenable to intervention via lifestyle factors as are mechanical unloading and nutritional deficiencies, and the reader is referred to the reviews cited in this paragraph for further information.…”

Section: Possible Mechanisms Of Bone Loss Induced By Obesity Treatmentsmentioning

confidence: 99%

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Harper

Pattinson

Fernando

et al. 2016

Hormone Molecular Biology and Clinical Investigation

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Background: New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. Materials and methods: This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. Results and conclusions: All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) -but not BMD -and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in

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Section: Possible Mechanisms Of Bone Loss Induced By Obesity Treatmentsmentioning

confidence: 99%

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Harper

Pattinson

Fernando

et al. 2016

Hormone Molecular Biology and Clinical Investigation

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show abstract

“…Patients may be treated inappropriately with assumption of other diagnoses like fibromyalgia, osteoarthritis, gout, intercostal neuralgia and even arthritis (14). Other than vitamin D deficiency and secondary hyperparathyroidism and osteomalacia, risk of osteoporosis, falls and fractures are also increased after bariatric surgery (1,3,11,13).…”

Section: Discussionmentioning

confidence: 99%

“…After surgery calcium and vitamin D absorption is compromised because of bypassing duodenum and proximal jejunum where normally they are absorbed. Mixing with biliopancreatic secretion in common channel and steatorrhea is another mechanism for calcium and vitamin D malabsorption (1)(2)(3)11). In a study from Sweden, 65% of patients had serum 25(OH) vitamin D levels less than 20 ng/dL and 69% had elevated PTH levels after a median time of 11±2.8 years postsurgery (4).…”

Section: Discussionmentioning

confidence: 99%

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Hypocalcemia and osteomalacia after bariatric surgery

Ghazi¹

2017

ccmbm

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SummaryIntroduction. Obesity has become a major health problem not only in industrialized societies but also in developing countries. Multiple studies have shown that bariatric surgery has been effective in reducing substantial amount of weight and also the comorbidities and is being performed more frequently as an established treatment. Due to anatomical and physiological alterations after surgery that impairs absorption of vitamin D and calcium, two fundamental factors in bone formation, their intestinal absorption is highly compromised. Case report. We present a 48-year-old woman who was visited in emergency room for generalized bone pain, perioral paresthesia and carpopedal spasm. She had undergone bariatric surgery 15 years ago. Chvostek's sign and Trousseau's sign were positive. Examination of thoracic ribs elicited severe pain on palpation. Laboratory evaluation revealed: Ca = 6.1 mg/dL, P= 2.1 mg/dL, alkaline phosphatase = 432 (160-303), PTH=541 pg/mL, and 25(OH)D3= 3 ng/mL. Whole body bone scan showed increased uptake in the anterior arc of left 6 th rib, posterior arc of left 6 th and 12 th ribs with increased uptake of costochondral joints. Conclusion. Our case highlights the possible consequences that bariatric surgery may have on bone and mineral health and the need for regular and proactive follow-up of the patients.

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“…Effects on serotonin are mixed. Hormones produced by the pancreas including insulin, proinsulin, glucagon and amylin also decrease [Swarbrick et al 2008, Holdstock et al 2003, Folli et al 2012, Brzozowska et al 2013, Hage and Fuleihan 2014. Many of these endocrine changes are considered to have negative consequences on bone health.…”

Section: The American Association Of Clinical Endocrinologists Thementioning

confidence: 99%

Effects of endocrine and inflammatory changes on markers of bone turnover following Roux-en-Y gastric bypass surgery

Rogers¹,

Havel²,

Wolfe³

et al. 2015

MRAJ

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Bariatric surgery and bone disease: from clinical perspective to molecular insights

Cited by 79 publications

References 118 publications

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

Hypocalcemia and osteomalacia after bariatric surgery

Effects of endocrine and inflammatory changes on markers of bone turnover following Roux-en-Y gastric bypass surgery

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