Effects of Roux-en-Y Gastric Bypass on Osteoclast Activity and Bone Density in Morbidly Obese Patients with Type 2 Diabetes

Abstract

Introduction-Roux-en-Y gastric bypass (RYGB) is a well-established treatment for morbid obesity and type 2 diabetes. The effects of RYGB on bone metabolism and bone health are largely unknown.Objective-Determine the changes in osteoclast function and bone density 1 year after RYGB as compared with a control group undergoing a diabetes support and education program (DSE).Design-A prospective cohort study with patients matched for weight and age assigned to RYGB or DSE. Setting-Large academic institution.Patients or Other Participants-Patients with type 2 diabetes mellitus and morbid obesity (body mass index greater than 35 kg/m 2 ).Intervention-Subjects either received laparoscopic RYBG or DSE, which consisted of nutritional, exercise, and dietary counseling performed by a certified diabetic educator and a nutritionist three times over a year.Main Outcome Measure-Osteoclast activity, bone mineral density.Results-One year after, intervention subjects undergoing RYGB have a 280% increase in osteoclast activity as compared with a 7.6% increase in the DSE control group (P < 0.001). Furthermore, there was a statistically significant increase in sclerostin levels in subjects undergoing RYGB compared with an increase in the control group. The total bone mineral density Laurel L Tangalakis,

Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis

“…Among the 15 articles evaluating the relationship between bariatric surgery and the lumbar spine, there were 2 [ 26 , 28 ] articles in which the average age of subjects was less than 30 years; 6 [ 32 , 34 , 35 , 37 , 41 , 44 ] articles included 30- to 40-year-old patients; and 7 [ 29 , 30 , 34 , 38 , 40 , 42 , 45 ] articles included patients older than 40 years of age. The age division was not clear in one of the articles [ 47 ]; therefore, we did not include this in the subgroup analysis.…”

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial

“…Bariatric surgery produces detrimental effects on bone health and there is a significant and non-uniform reduction in BMD across different bone sites [3,16,41,42]. In the short-term, the preferential bone loss at FN and weight-bearing sites suggests that this could be a response to unloading after weight loss [43,44]. Only a few previous studies, mainly focusing on standard RYGB, have evaluated long-term BMD outcomes.…”

The Impact of Bariatric Surgery on Bone Health: State of the Art and New Recognized Links

“…A recent trial on bone marker variation after RYGB found similar results, with increased CTX-1, P1NP and BSAP 2 years after surgery 40 . Another study addressing bariatric type 2 diabetic patients found that there was a significant 280% increase in osteoblast activity, and a significant decrease in BMD of lumbar spine (−4.0%, p<0.05) one year after RYGB 41 . Several studies to date have focused on BMD variation after RYGB, where most of them used DXA measurements and detected a prominent areal Bone Mineral Density (aBMD) decline at the proximal femur during the first year after surgery, with decreases that range from 6 and 11% 42 .…”