Two‐year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy

Maghrabi, Adam H.; Wolski, Kathy; Abood, Beth; Licata, Angelo A.; Pothier, Claire E.; Bhatt, Deepak L.; Nissen, Steven E.; Brethauer, Stacy A.; Kirwan, John P.; Schauer, Philip R.; Kashyap, Sangeeta R.

doi:10.1002/oby.21150

Cited by 96 publications

(98 citation statements)

References 26 publications

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“…These findings are consistent with our study, which found trends for greater femoral bone loss after RYGB than SG. In contrast, two recent studies found similar rates of vertebral and femoral bone loss in RYGB and SG patients (13, 14). However, artifacts associated with DXA-based BMD measurements in obesity and during weight loss (17, 18, 22, 33) may have confounded the interpretation of the true magnitude of bone loss and its determinants after bariatric surgery.…”

Section: Discussionmentioning

confidence: 74%

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Bredella

Greenblatt

Eajazi

et al. 2017

Bone

141

133

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Bariatric surgery is associated with bone loss but skeletal consequences may differ between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), the two most commonly performed bariatric procedures. Furthermore, severe weight loss is associated with high marrow adipose tissue (MAT); however, MAT is also increased in visceral adiposity. The purpose of our study was to determine the effects of RYGB and SG on BMD and MAT. We hypothesized that both bariatric procedures would lead to a decrease in BMD and MAT. We studied 21 adults with morbid obesity (mean BMI 44.1 ± 5.1 kg/m2) prior to and 12 months after RYGB (n=11) and SG (n=10). All subjects underwent DXA and QCT of the lumbar spine and hip to assess aBMD and vBMD. Visceral (VAT) and subcutaneous (SAT) adipose tissue was quantified at L1-2. MAT of the lumbar spine and femur was assessed by 1H-MR spectroscopy. Calcitropic hormones and bone turnover markers were determined. At 12 months after surgery, mean weight and abdominal fat loss was similar between the RYGB and SG groups. Mean serum calcium, 25(OH)-vitamin D, and PTH levels were unchanged after surgery and within the normal range in both groups. Bone turnover markers P1NP and CTX increased within both groups and P1NP increased to a greater extent in the RYGB group (p=0.03). There were significant declines from baseline in spine aBMD and vBMD within the RYGB and SG groups, although the changes were not significantly different between groups (p=0.3). Total hip and femoral neck aBMD by DXA decreased to a greater extent in the RYGB than the SG group (p<0.04) although the change in femoral vBMD by QCT was not significantly different between groups (p>0.2). MAT content of the lumbar spine and femoral diaphysis did not change from baseline in the RYGB group but increased after SG (p=0.03). Within the SG group, 12-month change in weight and VAT were positively associated with 12-month change in MAT (p<0.04), suggesting that subjects with less weight and VAT loss had higher MAT. In conclusion, RYGB and SG are associated with declines in lumbar spine BMD, however, the changes are not significantly different between the groups. RYGB may be associated with greater decline of aBMD at the total hip and femoral neck compared to SG. MAT content increased after SG and this was associated with lower weight and VAT loss.

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Section: Discussionmentioning

confidence: 74%

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Bredella

Greenblatt

Eajazi

et al. 2017

Bone

141

133

View full text Add to dashboard Cite

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“…These reductions in total hip BMD were between 0.010 and 0.015 g/cm 2 , which corresponds to an approximate change of 1%-1.5% from pretreatment values [34]. While statistically significant, these diet-induced reductions in hip BMD are considerably less than those associated with bariatric surgery (RYGB specifically), which showed a decline of 8%-11% from presurgical values in the first 12 months post surgery [10,50,56,59,60]. In accordance with the high variability of results, the lumbar spine showed no significant change in BMD with diet-induced weight loss [34].…”

Section: Effects Of Dietary Restriction On Bonementioning

confidence: 91%

“…It appears to have a greater detrimental effect on bone than gastric banding or sleeve gastrectomy -not only in terms of reducing BMD, at least at the hip, but also in terms of increasing the risk of osteoporotic fractures [10,50,[55][56][57][58]. Hip BMD has been shown to decrease by 8%-11% from pre-surgical values in the first 12 months after RYGB [10,50,56,59,60]. A systematic review and meta-analysis of 12 trials (three randomized controlled trials and nine quasi experimental trials) showed that reductions in hip BMD after RYGB or another less common bariatric procedure, biliopancreatic diversion, were significantly greater than the reductions induced by gastric banding or sleeve gastrectomy, when measured 12 months post surgery [56].…”

Section: Effect Of Bariatric Surgery On Bonementioning

confidence: 99%

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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“…reported a reduction of more than 9% in femoral bone mineral density two years after bariatric surgery, regardless of the surgical procedure (Roux-en-Y gastric bypass or vertical gastrectomy). However, what is remarkable is that 6/37 (16.2%) patients in surgery group experienced spontaneous fractures, which occurred in only 1/17 (5.9%) in the control group (8). Weight loss, even with lifestyle changes, is associated with a reduction in BMD, as observed in patients participating in the LookAhead Trial (9).…”

Section: T His Issue Of the Archives Of Endocrinology Andmentioning

confidence: 90%

The obesity puzzle: focus on bone turnover after bariatric surgery

Melo

2017

Arch. Endocrinol. Metab.

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T his issue of the Archives of Endocrinology andMetabolism encompasses three studies related to obesity. The influence of genetics on the development of metabolic obesity complications, quality of life of obese patients and bone metabolism after bariatric surgery are discussed in order to increase the knowledge of these aspects in this complex disease.The article "Prevalence of musculoskeletal symptoms in obese patients candidates for bariatric surgery and its impact on health related quality of life" by Calenzani and cols. emphasizes the relationship between obesity and musculoskeletal symptoms and their influence on physical and mental aspects linked to the quality of life. In addition to the classical metabolic disorders related to obesity that abbreviate patients' lives, the physical limitation caused by arthritis and joint deformities causes impairment in mobility, increasing sedentary lifestyle, with consequent reduction in energy expenditure (1). Obese patients reported a very high frequency of pain in ankles/feet, knees and lumbar region. These symptoms impair deambulation and, thus obesity withdraws the right to come and go of these patients, determining furthermore impairment in their quality of life (1). Differently from Brilmann and cols. (2), who found a negative correlation between body mass index (BMI) and quality of life scores assessed through SF-36, Calenzani and cols. did not observed this association, that could be consequence of the relatively small and homogenously class 3 obesity sample of patients, as emphasized by the authors (1).The relationship between two main metabolic disorders, diabetes mellitus type 2 (DM2) and systemic arterial hypertension (SAH), with 12 polymorphisms in the genes encoding ghrelin (GHRL, rs26802), uncoupling protein 2 (UCP2, rs659366), uncoupling protein 3 (UCP3, rs1800849), FTO (rs9939609), leptin (LEP, rs7799039), leptin receptor (LEPR, rs1137101), and serotonin receptor (5-HT2C, rs3813929) was investigated by Schnor and cols. and is reported in the paper "Association of 5-HT2C (rs3813929) and UCP3 (rs1800849) gene polymorphisms with type 2 diabetes in obese women candidates for bariatric surgery". The study, which evaluated 351 obese women candidates for bariatric surgery, reports a 5-fold increased risk of having DM2 in T allele carriers of the rs3813929 and a 3-fold increased risk also for DM2 in CC genotype carriers of the rs1800849 (3). Analyzes of polymorphic variants can frequently lead to conflicting results, either because of the sample size or mainly because of the genetic background. The genetic influence on complex diseases is more associated with the interaction of several polymorphisms than with isolated polymorphisms. Thus, while one single published article reported a similar finding concerning the polymorphism in the UCP3 gene, studies about the polymorphism in the 5-HT2C gene present controversial results (3).

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Two‐year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy

Cited by 96 publications

References 26 publications

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Effects of Roux-en-Y gastric bypass and sleeve gastrectomy on bone mineral density and marrow adipose tissue

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

The obesity puzzle: focus on bone turnover after bariatric surgery

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