Abstract
Background
The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone mineral density (BMD) 1 to 5 years after RYGB.
Methods
We designed a retrospective cohort study in 26 postmenopausal women (58.0 ± 3.9 years old) with RYGB 3.5 ± 1.1 years before (body mass index (BMI) 29.5 ± 3.8 kg/m2, presurgery 43.6 ± 5.5 kg/m2) and 26 nonoperated women (57.5 ± 4.7 years old, BMI 29.2 ± 4.1 kg/m2) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin.
Results
RYGB group, compared to nonoperated women, had higher CTx (0.71 ± 0.21 vs. 0.43 ± 0.15 ng/ml; P < 0.01) and PTH (68.3 ± 35 vs. 49.4 ± 16 pg/ml; P = 0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759 ± 457 vs. 705 ± 460 mg/day; 176 ± 160 vs. 111 ± 86 UI/day), ghrelin (763 ± 336 vs. 621 ± 274 pg/ml), ALP (101 ± 22 vs. 94 ± 25 UI/l), 25OHD (18.8 ± 7.6 vs. 17.4 ± 5.9 ng/ml), lumbar spine BMD (1.059 ± 0.32 vs. 1.071 ± 0.207 g/cm2), or femoral neck BMD (0.892 ± 0.109 vs. 0.934 ± 1.1 g/cm2).
Conclusions
RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB.
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References
Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;375:753–61.
Decker GA, Swain JM, Crowell MD, et al. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:2571–80.
Wucher H, Ciangura C, Poitou C, et al. Effects of weight loss on bone status after bariatric surgery: association between adipokines and bone markers. Obes Surg. 2008;18:58–65.
Reid IR. Relationships among body mass, its components, and bone. Bone. 2002;31:547–55.
Escalona A, Devaud N, Pérez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis. 2007;3:423–7.
Salamone LM, Dallal GE, Zantos D, et al. Contributions of vitamin D intake and seasonal exposure to plasma 25-hydroxivitamin D concentration in elderly women. Am J Clin Nutr. 1994;59:80–6.
Castillo O, Rozowski J, Muñoz X, et al. Nutrient intake in Chilean vegetarians. Rev Chil Nutr. 1998;25:39–44.
González G, Alvarado JN, Rojas A, et al. High prevalence of vitamin D deficiency in Chilean healthy postmenopausal women with normal sun exposure: additional evidence for a worldwide concern. Menopause. 2007;14:455–61.
Goode LR, Brolin RE, Chowdhury HA, et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40–7.
US Department of Health and Human Services, US Department of Agriculture Dietary Guidelines for Americans. https://doi.org/www.health.gov/dietaryguidelines/dga2005/default.htm (2005). Accessed October 31, 2008.
Garnero P, Borel O, Delmas PD. Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clin Chem. 2001;47:694–702.
Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–5.
Shapses S, Riedt C. Bone, body weight, and weight reduction: what are the concerns? J Nutr. 2006;136:1453–6.
O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–340.
Riedt CS, Brolin RE, Sherrel RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity. 2006;14:1940–8.
Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18:145–50.
Rueda S, Fernández-Fernández C, Romero F, et al. Vitamin D, PTH, and metabolic syndrome in severely obese subjects. Obes Surg. 2008;18:151–4.
Carlin AM, Rao DS, Yager KM, et al. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surg Obes Relat Dis 2008; in press.
Johnson JM, Maher JW, DeMaria EJ, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006;243:701–4.
Jin J, Robinson AV, Hallowell PT, et al. Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery. 2007;142:914–20.
Fleischer J, Stein EM, Bessler M, et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008;93:3735–40.
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.
Lehto-Axtelius D, Stenstrom M, Johnell O. Osteopenia after gastrectomy, fundectomy or antrectomy: an experimental study in the rat. Regul Pept. 1998;78:41–50.
van der Velde M, Delhanty P, van der Eerden B, et al. Ghrelin and bone. Vitam Horm. 2008;77:239–58.
Misra M, Miller KK, Stewart V, et al. Ghrelin and bone metabolism in adolescent girls with anorexia nervosa and healthy adolescents. J Clin Endocrinol Metab. 2005;90:5082–7.
Huda MS, Durham BH, Wong SP, et al. Lack of an acute effect of ghrelin on markers of bone turnover in healthy controls and post-gastrectomy subjects. Bone. 2007;41:406–13.
von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53:918–21.
De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–8.
Patel R, Blake GM, Rymer J, et al. Long-term precision of DXA scanning assessed over seven years in forty postmenopausal women. Osteoporos Int. 2000;11:68–75.
Woitge HW, Seibel MJ, Ziegler R. Comparison of total and bone-specific alkaline phosphatase in patients with nonskeletal disorder or metabolic bone diseases. Clin Chem. 1996;42:1796–804.
Garnero P, Sornay-Rendu E, Duboeuf F, et al. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res. 1999;14:1614–21.
Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18–28.
Acknowledgements
This study was supported by funds from the Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile. We would like to thank Ms. Susan Smalley M. for her critical review in English of our manuscript and to Ms. Jacqueline Parada for the CTx measurements.
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Valderas, J.P., Velasco, S., Solari, S. et al. Increase of Bone Resorption and the Parathyroid Hormone in Postmenopausal Women in the Long-term after Roux-en-Y Gastric Bypass. OBES SURG 19, 1132–1138 (2009). https://doi.org/10.1007/s11695-009-9890-y
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DOI: https://doi.org/10.1007/s11695-009-9890-y