Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement

Kim, Julie; Nimeri, Abdelrahman; Khorgami, Zhamak; Chaar, Maher El; Galvez, Alvaro; Vosburg, R. Wesley

doi:10.1016/j.soard.2020.09.031

Cited by 28 publications

(25 citation statements)

References 63 publications

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“…The deleterious effect on bone is multifactorial and depends on the type of procedure, the degree of weight loss, micronutrient deficiencies and hormonal changes [27][28][29]. Regarding the changes that we describe in the postsurgical phosphocalcic laboratory, although most studies report that the vitamin D deficit worsens after BS due to its malabsorption [27,28,30], we found a significant increase in Vitamin D levels after BS. One review mentions an initial increase in Vitamin D levels two years after BS, which then drops after five years of follow-up [31].…”

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

“…It has been widely described that BS is associated with abnormalities of bone mineral metabolism, such as accelerated remodeling, increased turnover and bone loss, and decreased bone mineral density [27,28]. The deleterious effect on bone is multifactorial and depends on the type of procedure, the degree of weight loss, micronutrient deficiencies and hormonal changes [27][28][29]. Regarding the changes that we describe in the postsurgical phosphocalcic laboratory, although most studies report that the vitamin D deficit worsens after BS due to its malabsorption [27,28,30], we found a significant increase in Vitamin D levels after BS.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, the drop in bone mineral density after BS has been widely described [36]. The etiology is multifactorial: lower calcium intake, lower intestinal absorption of calcium (due to lower gastric acidity and the bypass of the proximal intestine) and lower mechanical load [27]. Bone resorption markers increase to a greater extent than those of formation, leading to a net loss of bone; yet, the clinical relevance of this fact is unknown [29,36].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Bariatric Surgery in A Cohort of Patients with Type 2 Diabetes and Obesity

Soutelo¹,

Clara²,

Yanina³

et al. 2021

COS

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Impact of Bariatric Surgery in A Cohort of Patients with Type 2 Diabetes and Obesity

Soutelo¹,

Clara²,

Yanina³

et al. 2021

COS

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“…Therefore, this might represent the main therapeutical window for mitigating bone loss in male patients. Guideline recommendations regarding post-surgical medical and nutritional therapy are heterogeneous and non-gender oriented, but they all stress the need to ensure adequacy of calcium (1200-1500mg/day), vitamin D (3000UI/day, with a goal of >30ng/mL), protein (a minimal of 60 g/day and up to 1.5 g/kg ideal body weight per day), and physical exercise [52][53][54]. Since the loss of lean mass has been shown to positively correlate with the bone loss [55,56], its preservation might also represent an intervention target.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density Trends During the First Year After Laparoscopic Sleeve Gastrectomy—a Cohort Study on 241 Patients

et al. 2021

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Purpose Laparoscopic sleeve gastrectomy (LSG) is an effective weight loss procedure, but detrimental effects on bone health have been described. We aimed to assess the dynamics of regional and total bone mineral density (BMD) in a cohort of patients undergoing LSG and to capture gender differences in terms of evolution. Materials and Methods We conducted a retrospective study on 241 patients who underwent LSG to determine the regional and total BMD changes at 6 and 12 months after the intervention. Results One hundred ten males and 140 females (97 pre-, 43 postmenopausal) were included. Mean baseline body mass index (BMI) was 44.16 ± 6.11 kg/m2 in males and 41.60 ± 5.54 kg/m2 in females, reaching 28.62 ± 4.26 kg/m2 and 27.39 ± 4.2 kg/m2, respectively, at 12 months. BMD showed a continuous decline, with significant loss from 6 months postoperatively. There was a positive correlation between BMD and BMI decline at 12 months (r = 0.134, p < 0.05). Total BMD loss at 12 months was significantly greater in males than premenopausal females, independent of BMI variation and age. During the first 6 months, men lost significantly more bone mass than premenopausal and postmenopausal women (BMD variation was 2.62%, 0.27%, 1.58%, respectively). The second period (6–12 months) was similar in all three groups, revealing a further steady (~ 1.4%) BMD decline. Conclusions Our results are consistent with previous findings that LSG negatively impacts BMD, stressing the importance of bone health-oriented measures in postoperative care. Moreover, the impact that seems more significant in males warrants future exploration, as it might change clinical practice. Graphical abstract

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Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

Giustina,

di Filippo,

Facciorusso

et al. 2023

Rev Endocr Metab Disord

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Bariatric surgery is associated with a postoperative reduction of 25(OH) vitamin D levels (25(OH)D) and with skeletal complications. Currently, guidelines for 25(OH)D assessment and vitamin D supplementation in bariatric patients, pre- and post-surgery, are still lacking. The aim of this work is to analyse systematically the published experience on 25(OH)D status and vitamin D supplementation, pre- and post-surgery, and to propose, on this basis, recommendations for management. Preoperatively, 18 studies including 2,869 patients were evaluated. Prevalence of vitamin D insufficiency as defined by 25(OH)D < 30 ng/mL (75 nmol/L) was 85%, whereas when defined by 25(OH)D < 20 ng/mL (50 nmol/L) was 57%. The median preoperative 25(OH)D level was 19.75 ng/mL. After surgery, 39 studies including 5,296 patients were analysed and among those undergoing either malabsorptive or restrictive procedures, a lower rate of vitamin D insufficiency and higher 25(OH)D levels postoperatively were observed in patients treated with high-dose oral vitamin D supplementation, defined as ≥ 2,000 IU/daily (mostly D3-formulation), compared with low-doses (< 2,000 IU/daily). Our recommendations based on this systematic review and meta-analysis should help clinical practice in the assessment and management of vitamin D status before and after bariatric surgery. Assessment of vitamin D should be performed pre- and postoperatively in all patients undergoing bariatric surgery. Regardless of the type of procedure, high-dose supplementation is recommended in patients after bariatric surgery.

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Metabolic bone changes after bariatric surgery: 2020 update, American Society for Metabolic and Bariatric Surgery Clinical Issues Committee position statement

Cited by 28 publications

References 63 publications

Impact of Bariatric Surgery in A Cohort of Patients with Type 2 Diabetes and Obesity

Impact of Bariatric Surgery in A Cohort of Patients with Type 2 Diabetes and Obesity

Bone Mineral Density Trends During the First Year After Laparoscopic Sleeve Gastrectomy—a Cohort Study on 241 Patients

Vitamin D status and supplementation before and after Bariatric Surgery: Recommendations based on a systematic review and meta-analysis

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