TY - JOUR
T1 - Bone structural changes after gastric bypass surgery evaluated by HR-pQCT
T2 - a two-year longitudinal study
AU - Shanbhogue, Vikram V
AU - Støving, René Klinkby
AU - Frederiksen, Katrine Hartmund
AU - Hanson, Stine
AU - Brixen, Kim
AU - Gram, Jeppe
AU - Jørgensen, Niklas Rye
AU - Hansen, Stinus
N1 - © 2017 The authors.
PY - 2017/6
Y1 - 2017/6
N2 - Objective, design and methods: Roux-en-Y gastric bypass (RYGB) has proved successful in attaining sustained weight loss but may lead to metabolic bone disease. To assess impact on bone mass and structure, we measured a real bone mineral density at the hip and spine by dual-energy X-ray absorptiometry, and volumetric BMD (vBMD) and bone microarchitecture at the distal radius and tibia by high-resolution peripheral quantitative CT in 25 morbidly obese subjects (15 females, 10 males) at 0, 12 and 24 months after RYGB. Bone turnover markers (BTMs), calciotropic and gut hormones and adipokines were measured at the same time points. Results: After a 24.1% mean weight loss from baseline to month 12 (P < 0.001), body weight plateaued from month 12 to 24 (-0.9%, P = 0.50). However, cortical and trabecular vBMD and microarchitecture deteriorated through the 24 months, such that there was a 5 and 7% reduction in estimated bone strength at the radius and tibia respectively (both P < 0.001). The declines observed in the first 12 months were matched or exceeded by declines in the 12-To 24-month period. While a significant increase in BTMs and decrease in leptin and insulin were seen at 24 months, these changes were maximal at month 12 and stabilized from month 12 to 24. Conclusions: Despite weight stabilization and maintenance of metabolic parameters, bone loss and deterioration in bone strength continued and were substantial in the second year. The clinical importance of these changes in terms of increased risk of developing osteoporosis and fragility fractures remain an important concern.
AB - Objective, design and methods: Roux-en-Y gastric bypass (RYGB) has proved successful in attaining sustained weight loss but may lead to metabolic bone disease. To assess impact on bone mass and structure, we measured a real bone mineral density at the hip and spine by dual-energy X-ray absorptiometry, and volumetric BMD (vBMD) and bone microarchitecture at the distal radius and tibia by high-resolution peripheral quantitative CT in 25 morbidly obese subjects (15 females, 10 males) at 0, 12 and 24 months after RYGB. Bone turnover markers (BTMs), calciotropic and gut hormones and adipokines were measured at the same time points. Results: After a 24.1% mean weight loss from baseline to month 12 (P < 0.001), body weight plateaued from month 12 to 24 (-0.9%, P = 0.50). However, cortical and trabecular vBMD and microarchitecture deteriorated through the 24 months, such that there was a 5 and 7% reduction in estimated bone strength at the radius and tibia respectively (both P < 0.001). The declines observed in the first 12 months were matched or exceeded by declines in the 12-To 24-month period. While a significant increase in BTMs and decrease in leptin and insulin were seen at 24 months, these changes were maximal at month 12 and stabilized from month 12 to 24. Conclusions: Despite weight stabilization and maintenance of metabolic parameters, bone loss and deterioration in bone strength continued and were substantial in the second year. The clinical importance of these changes in terms of increased risk of developing osteoporosis and fragility fractures remain an important concern.
KW - Absorptiometry, Photon
KW - Adiponectin/metabolism
KW - Adult
KW - Bone Density
KW - Bone Diseases, Metabolic/diagnostic imaging
KW - Bone Remodeling
KW - Collagen Type I/metabolism
KW - Female
KW - Follicle Stimulating Hormone/metabolism
KW - Gastric Bypass/adverse effects
KW - Hip Joint/diagnostic imaging
KW - Humans
KW - Insulin/metabolism
KW - Leptin/metabolism
KW - Longitudinal Studies
KW - Lumbar Vertebrae/diagnostic imaging
KW - Luteinizing Hormone/metabolism
KW - Male
KW - Middle Aged
KW - Obesity, Morbid/surgery
KW - Osteoporosis/diagnostic imaging
KW - Parathyroid Hormone/metabolism
KW - Peptide Fragments/metabolism
KW - Peptides/metabolism
KW - Postoperative Complications/diagnostic imaging
KW - Procollagen/metabolism
KW - Radius/diagnostic imaging
KW - Tibia/diagnostic imaging
KW - Tomography, X-Ray Computed
KW - Vitamin D/analogs & derivatives
KW - Weight Loss
U2 - 10.1530/EJE-17-0014
DO - 10.1530/EJE-17-0014
M3 - Journal article
C2 - 28289103
SN - 0804-4643
VL - 176
SP - 685
EP - 693
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 6
ER -
