TY - JOUR
T1 - Effects of Gastric Bypass and Gastric Banding on Bone Remodeling in Obese Patients with Type 2 Diabetes
AU - Yu, Elaine W
AU - Wewalka, Marlene
AU - Ding, Su-Ann
AU - Simonson, Donald C
AU - Foster, Kathleen
AU - Holst, Jens J
AU - Vernon, Ashley
AU - Goldfine, Allison B
AU - Halperin, Florencia
PY - 2016/2
Y1 - 2016/2
N2 - Context: Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banDing (LAGB) or mechanisms underlying bone loss after bariatric surgery. Objective: To evaluate effects of RYGB and LAGB on fasting and postprandial indices of bone remodeling. Design and Setting: Ancillary investigation of a prospective study at 2 academic institutions. Participants: Obese adults aged 21-65 years with type 2 diabetes who underwent RYGB (n 11) or LAGB (n 8). Outcomes: Serum C-terminal telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and PTH were measured during a mixed meal tolerance test at baseline, 10 days and 1 year after surgery. Changes in 25-hydroxyvitamin D, polypeptide YY (PYY), glucagon-like peptide-1, glucosedependent insulinotropic peptide, and insulin were also assessed. Results: Fasting CTX increased 10 days after RYGB but not LAGB (69 α 23% vs 12α12%, P .001), despite comparable weight loss at that time. By 1 year, fasting CTX and P1NP increased more after RYGB than LAGB (CTX 221 α 60% vs 15 α 6%, P0.001; P1NP <93 α 25% vs-9 α 10%, P < .001) and weight loss was greater with RYGB. Changes in CTX were independent of PTH and 25-hydroxyvitamin D but were associated with increases in fasting PYY. Postprandial suppression of CTX was more pronounced after RYGB than LAGB at 10 days and 1 year postoperatively. Conclusions: RYGB is accompanied by early increases in fasting indices of bone remodeling, independent of weight loss or changes in PTH or 25-hydroxyvitamin D. LAGB did not affect bone markers. PYY and other enterohormonal signals may play a role in RYGB-specific skeletal changes.
AB - Context: Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banDing (LAGB) or mechanisms underlying bone loss after bariatric surgery. Objective: To evaluate effects of RYGB and LAGB on fasting and postprandial indices of bone remodeling. Design and Setting: Ancillary investigation of a prospective study at 2 academic institutions. Participants: Obese adults aged 21-65 years with type 2 diabetes who underwent RYGB (n 11) or LAGB (n 8). Outcomes: Serum C-terminal telopeptide (CTX), procollagen type 1 N-terminal propeptide (P1NP), and PTH were measured during a mixed meal tolerance test at baseline, 10 days and 1 year after surgery. Changes in 25-hydroxyvitamin D, polypeptide YY (PYY), glucagon-like peptide-1, glucosedependent insulinotropic peptide, and insulin were also assessed. Results: Fasting CTX increased 10 days after RYGB but not LAGB (69 α 23% vs 12α12%, P .001), despite comparable weight loss at that time. By 1 year, fasting CTX and P1NP increased more after RYGB than LAGB (CTX 221 α 60% vs 15 α 6%, P0.001; P1NP <93 α 25% vs-9 α 10%, P < .001) and weight loss was greater with RYGB. Changes in CTX were independent of PTH and 25-hydroxyvitamin D but were associated with increases in fasting PYY. Postprandial suppression of CTX was more pronounced after RYGB than LAGB at 10 days and 1 year postoperatively. Conclusions: RYGB is accompanied by early increases in fasting indices of bone remodeling, independent of weight loss or changes in PTH or 25-hydroxyvitamin D. LAGB did not affect bone markers. PYY and other enterohormonal signals may play a role in RYGB-specific skeletal changes.
U2 - 10.1210/jc.2015-3437
DO - 10.1210/jc.2015-3437
M3 - Journal article
C2 - 26600045
SN - 0021-972X
VL - 101
SP - 714
EP - 722
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 2
ER -
