Changes in bone mineral density following laparoscopic sleeve gastrectomy: 2-year outcomes

Evaluation of bone density and skeletal muscle mass after sleeve gastrectomy using computed tomography method

“…Because sleeve gastrectomy decreases gastric volume, food digestion and absorption may be unaffected, showing that our BMD results obtained using the HU of the lumbar spine also remained unchanged. Our study revealed no significant changes in the BMD of the lumbar spine evaluated by CT imaging, which is consistent with the results of previous studies that reported no significant difference preoperatively and postoperatively in the BMD of the lumbar spine after sleeve gastrectomy ( Jaruvongvanich et al, 2019 ; Ben-Porat et al, 2022 ).…”

“…In this study, preoperative and postoperative examinations of abdominal CT scans were performed as routine tests for preoperative planning and postoperative evaluation and to obtain bone and psoas muscle density and psoas muscle cross-sectional area with relative ease. Our study, using HU obtained from abdominal CT scans, showed the same bone density of the lumbar spine after sleeve gastrectomy despite weight loss, which is consistent with that reported in previous studies ( Jaruvongvanich et al, 2019 ; Ben-Porat et al, 2022 ). Roux-en-Y gastric bypass surgery resulted in lower postoperative BMD as assessed by DXA in the total proximal femur, femoral neck, and lumbar spine and higher fracture risk than sleeve gastrectomy ( Hofso et al, 2021 ; Cadart et al, 2020 ).…”

“…First, it was a retrospective study analyzing clinical data. Second, the study duration was short, i.e., analyzing 1 year postoperatively; nevertheless, studies analyzing the long-term duration of bariatric surgery have demonstrated no remarkable changes in the 1-year follow-up, as reported previously ( Ben-Porat et al, 2022 ; Malinici et al, 2021 ; Vilarrasa et al, 2011 ). Third, we analyzed only the BMD of the lumbar spine using CT images.…”

“…Most studies examining BMD of the lumbar spine, total proximal femur, and femoral neck after sleeve gastrectomy have used DXA ( Jaruvongvanich et al, 2019 ; Bredella et al, 2017 ; Ruiz-Tovar et al, 2013 ), which may fail to obtain accurate measurements in patients with severe obesity because the excess fat tissue around the bones could interrupt the measurement ( Tothill et al, 1997 ; Bolotin, 1998 ). A previous study on the analysis of postoperative 2-year BMD by DXA after sleeve gastrectomy reported lower postoperative BMD of the total proximal femur and femoral neck, but not in the lumbar spine ( Ben-Porat et al, 2022 ). In this study, we analyzed the BMD of the lumbar spine using preoperative and postoperative abdominal CT scans.…”

“…In Particular, a significant decrease in postoperative BMD as assessed by DXA in the lumbar spine, total proximal femur, and femoral neck was observed after sleeve gastrectomy due to the reduction of mechanical load on the skeleton owing to weight loss ( Bredella et al, 2017 ; Liu et al, 2016 ). Conversely, some studies reported no loss in BMD as assessed by DXA after sleeve gastrectomy in the lumbar spine ( Jaruvongvanich et al, 2019 ; Ben-Porat et al, 2022 ), suggesting that the effect on bones after sleeve gastrectomy remains controversial. Most studies examining BMD of the lumbar spine, total proximal femur, and femoral neck after sleeve gastrectomy have used DXA ( Jaruvongvanich et al, 2019 ; Bredella et al, 2017 ; Ruiz-Tovar et al, 2013 ), which may fail to obtain accurate measurements in patients with severe obesity because the excess fat tissue around the bones could interrupt the measurement ( Tothill et al, 1997 ; Bolotin, 1998 ).…”