Evaluation of Bone Disease in Morbidly Obese Women After Gastric Bypass and Risk Factors Implicated in Bone Loss

Vilarrasa, Núria; Gómez, José Manuel; Elío, Iñaki; Gómez-Vaquero, Carmen; Masdevall, Carlos; Pujol, Jordi; Virgili, N.; Burgos, R.; Sánchez-Santos, Raquel; Gordejuela, Amador García Ruiz de; Soler, Joan

doi:10.1007/s11695-009-9843-5

Cited by 84 publications

(77 citation statements)

References 37 publications

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“…The change in BMD was evident 1 year postsurgery and was associated with the degree of weight reduction [105]. The marked weight loss after long limbbiliopancreatic diversion (BPD-LL) has been associated with decrease in BMD 1 year after surgery [103], RYGB in morbidly obese patients decreases BMC and BMD 1 year postoperatively [106] and, similarly, in a study with follow-up for a year after gastric bypass surgery there was total hip BMD decrease as well as at the lumbar spine [107]. Fewer data are available for the relatively newer sleeve gastrectomy.…”

Section: Effects Of Bariatric Surgery On Bmdmentioning

confidence: 88%

Obesity and bone metabolism

2018

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The interaction between obesity and bone metabolism is complex. The effects of fat on the skeleton are mediated by both mechanical and biochemical factors. Though obesity is characterized by higher bone mineral density, studies conducted on bone microarchitecture have produced conflicting results. The majority of studies indicate that obesity has a positive effect on skeletal strength, even though most likely the effects are site-dependent and, in fact, obese individuals might be at risk of certain types of fractures. Mechanical loading and higher lean mass are associated with improved outcomes, whereas systemic inflammation, observed especially with abdominal obesity, may exert negative effects. Weight loss interventions likely lead to bone loss over time. Pharmacological treatment options seem to be safe in terms of skeletal health; however, the skeletal effects of bariatric surgery are dependent on the type of surgical procedure. Malabsorptive procedures are associated with higher short-term adverse effects on bone health. In this narrative review, we discuss the effects of obesity and weight loss interventions on skeletal health.

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Section: Effects Of Bariatric Surgery On Bmdmentioning

confidence: 88%

Obesity and bone metabolism

2018

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“…However, although some studies showed no significant change in lumbar spine BMD after RYGB surgery [52,53,64], several other studies have reported a significant decline in lumbar spine BMD that varied from 3 to 7 % compared with baseline at 9-12 months post-surgery [55,63,65], with an additional 3 % decrement in one of the studies at 3 years post-surgery [63].…”

Section: Effects Of Roux-en-y Gastric Bypass (Rygb) On Bonementioning

confidence: 93%

“…In accordance with previously described studies [52,63], a recent study of 22 women examined 12 months post-RYGB surgery found that their BMD had decreased by an average of 7.26 % in the lumbar spine, by 8.78 % in the femoral neck, and by 8.59 % at total femur, with associated hyperparathyroidism and elevated urinary concentrations of the bone resorption marker urine N-terminal telopeptide (NTx) [65]. This post-operative bone mass loss occurred in spite of a doubling of 25-hydroxy vitamin D intake amongst study patients via monitored use of multivitamin supplement and regular doses of cholecalciferol.…”

Section: Effects Of Roux-en-y Gastric Bypass (Rygb) On Bonementioning

confidence: 99%

“…Several studies [45,[52][53][54][55][56][57][58][59][60][61][62][63][64] have examined the effects of RYGB for morbid obesity on bone mineral density and/or bone turnover. Further corroborating the observed loss of bone, these studies have shown alterations in urinary or circulating concentrations of bone turnover markers.…”

Section: Effects Of Roux-en-y Gastric Bypass (Rygb) On Bonementioning

confidence: 99%

“…Prospective studies which assessed changes in BMD up to 3 years [63] after RYGB in men, as well as in women in various menopausal stages, reported the greatest BMD reduction to be in the femoral neck, where the BMD decline was between 9.2 and 10.9 % compared with baseline values [52,65], and total hip BMD losses ranging from 8 to 10.5 % [58,63].…”

Section: Effects Of Roux-en-y Gastric Bypass (Rygb) On Bonementioning

confidence: 99%

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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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