Bone Mineral Changes in Spine and Proximal Femur in Individual Obese Women after Laparoscopic Sleeve Gastrectomy: A Short-Term Study

Pluskiewicz, Wojciech; Bužga, Marek; Holéczy, Pavol; L, Bortlík; Smajstrla, Vit; Adamczyk, Piotr

doi:10.1007/s11695-012-0654-8

Cited by 66 publications

(47 citation statements)

References 27 publications

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“…These findings for sleeve gastrectomy are in keeping with a trial of shorter duration in 29 women, which was not included in the above-mentioned systematic review and meta-analysis [61]. Indeed, at 6 months post sleeve gastrectomy, BMD losses relative to pre-surgery values were observed at the hip (-0.059 ± 0.030 g/cm 2 or -5.2%) and femoral neck (-0.072 ± 0.046 g/cm 2 or -7.0%), with a slight but significant decrease at the lumbar spine [61].…”

Section: Effect Of Bariatric Surgery On Bonesupporting

confidence: 59%

“…The change from pre-surgical values in hip BMD in the RYGB group (nine trials involving RYGB and one trial involving biliopancreatic diversion) was -0.12 g/cm 2 , and in the other surgical group (one trial involving gastric banding and two trials involving sleeve gastrectomy) it was -0.04 g/cm 2 [56]. These findings for sleeve gastrectomy are in keeping with a trial of shorter duration in 29 women, which was not included in the above-mentioned systematic review and meta-analysis [61]. Indeed, at 6 months post sleeve gastrectomy, BMD losses relative to pre-surgery values were observed at the hip (-0.059 ± 0.030 g/cm 2 or -5.2%) and femoral neck (-0.072 ± 0.046 g/cm 2 or -7.0%), with a slight but significant decrease at the lumbar spine [61].…”

Section: Effect Of Bariatric Surgery On Bonementioning

confidence: 72%

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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: Effect Of Bariatric Surgery On Bonesupporting

confidence: 59%

Section: Effect Of Bariatric Surgery On Bonementioning

confidence: 72%

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

View full text Add to dashboard Cite

show abstract

“…Moreover, Pluskiewicz et al [1] reported follow up data for only 6 months, which may explain their inability to uncover these changes as we did through a 1-year follow-up period.…”

mentioning

confidence: 66%

“…

We would like to address some of the questions that Dr. Pluskiewicz et al [1] raises in his recent letter. Bone mineral density (BMD) measurements are affected by precision and accuracy errors.

…”

mentioning

confidence: 97%

Changes in Bone Mineral Density in Women Following 1-year Gastric Bypass Surgery, Published by Casagrande DS et al.—Reply

2013

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We would like to address some of the questions that Dr. Pluskiewicz et al. [1] raises in his recent letter. Bone mineral density (BMD) measurements are affected by precision and accuracy errors. Precision errors, usually evaluated in terms of the coefficient of variation (CV), measure the reproducibility of BMD results in individual patients and can be demonstrated by performing repeated scans on a representative sample. The BMD changes observed on follow-up scans can be interpreted as the least significant change (LSC), equal to approximately three times the CV. Changes greater than the LSC would be regarded as clinically significant [2,3].In the São Lucas Hospital of Pontificia Universidade Católica do Rio Grande do Sul (HSL PUCRS) where the dual-energy Xray absorptiometry exams were made, the CV is 2 % in the lumbar spine and 3 % in the proximal femur (femoral neck and total femur), and the LSC is 5.6 % for the lumbar spine and 8.5 % for the proximal femur. Applying this method of evaluation to our data means that BMD results for women reported in our study [4] decreased 7.3, 8.8, and 8.6 % in the lumbar spine, femoral neck, and total femur, respectively, after gastric bypass surgery. We have not reported our results using the LSC, as this index was questioned due to changes associated with the patient's BMI [3]. Such considerations imply that clinically significant differences between successive BMD results obtained from smaller patients may be unidentified and changes in larger patients may be inappropriately identified as valid [3].As BMD results depend on multiple factors other than those determined by bariatric surgery, it is clear that not in all subjects after the procedure we should expect significant bone changes. Moreover, Pluskiewicz et al.[1] reported follow up data for only 6 months, which may explain their inability to uncover these changes as we did through a 1-year follow-up period.

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“…Another prospective, 6-month study [49] examined BMD changes in 29 obese women with a mean BMI of 43 ± 5 kg/m2 after laparoscopic sleeve gastrectomy and found that their BMD decreased by 1.2 % at the lumbar spine, 7.0 % at the femoral neck and 5.2 % at the total hip. All differences from baseline were significant.…”

Section: Effects Of Sleeve Gastrectomy On Bonementioning

confidence: 99%

Bariatric Surgery and Bone Loss: Do We Need to Be Concerned?

Brzozowska

Sainsbury

Eisman

et al. 2014

Clinic Rev Bone Miner Metab

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Despite significant improvement in weight and comorbid conditions, there is growing evidence that bariatric surgery may exert a negative effect on the skeleton. This review has focused on the impact of bariatric surgery on bone health, with the concern that bariatric surgery may increase skeletal fragility and fracture risk by accelerating bone loss. We have highlighted studies evaluating changes in bone metabolism after three commonly performed bariatric procedures including laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass surgery and increasingly popular sleeve gastrectomy. This review has also discussed some of the technical issues faced in measuring bone in obese populations and during dynamic weight loss. There is limited evidence regarding potential mechanisms for the reported observations of increased bone turnover and/or bone loss after bariatric surgery. We have reviewed the evidence surrounding potential factors affecting bone health in bariatric patients such as rapid weight loss per se, nutritional deficiencies, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. Future prospective long-term cohort studies are needed to define how to quantify bone loss in individuals with obesity, particularly following massive weight loss, and for how long the bone changes continue. These studies will help clarify any negative clinical consequences of these changes, including future fracture risk in this unique group of patients. IntroductionThe prevalence of obesity worldwide has increased significantly in recent decades because of a complex range of environmental and possibly also epigenetic factors. Obesity is associated with increased mortality [1] with reduced life expectancy, especially amongst people affected from young adulthood [2], as well as multiple comorbidities including type 2 diabetes, hyperlipidemia, sleep apnoea, malignancy and decreased quality of life [3].The medical management of obesity is limited by the variable, limited response to treatment, suboptimal compliance and adverse effects of antiobesity medications. At present, the only effective, long-term treatment for obesity remains bariatric surgery, which results in substantial and sustained weight loss, significant reductions in comorbid conditions, and prolonged longevity [4]. In fact, the utilization of bariatric surgery as a therapeutic approach to morbid obesity has increased two and a half-fold worldwide between 2003 and 2011 [5].Although many studies have demonstrated the short-and long-term efficacy of bariatric surgery for weight loss, there are limited data regarding any long-term side effects of these procedures. Recently, there has been an increased focus on the impact of bariatric surgery on bone metabolism, with the concern that bariatric surgery may increase skeletal fragility and fracture risk by accelerating bone loss.The majority of research performed in this area has been cross-sectional and provides little evidence as to the possible mechanisms for any observed abnormal...

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Bone Mineral Changes in Spine and Proximal Femur in Individual Obese Women after Laparoscopic Sleeve Gastrectomy: A Short-Term Study

Cited by 66 publications

References 27 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

Changes in Bone Mineral Density in Women Following 1-year Gastric Bypass Surgery, Published by Casagrande DS et al.—Reply

Bariatric Surgery and Bone Loss: Do We Need to Be Concerned?

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