Bone structural changes after gastric bypass surgery evaluated by HR-pQCT: a two-year longitudinal study

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 -