Igor H Murai1, Hamilton Roschel1,2, Wagner S Dantas1, Saulo Gil1, Carlos Merege-Filho1, Roberto de Cleva3, Ana L de Sá-Pinto2, Fernanda Lima2, Marco A Santo3, Fabiana B Benatti1,4, John P Kirwan5, Rosa M Pereira2, Bruno Gualano1,2. 1. Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil. 2. Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil. 3. Gastroenterology Department, Digestive Surgery Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil. 4. School of Applied Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. 5. Integrative Physiology and Molecular Metabolism Group, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Abstract
CONTEXT: Bone loss after bariatric surgery potentially could be mitigated by exercise. OBJECTIVE: To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss. DESIGN: Randomized, controlled trial. SETTING:Referral center for bariatric surgery. PATIENTS: Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB). INTERVENTION: Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only). OUTCOMES: Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes. RESULTS: Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium). CONCLUSION: Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.
RCT Entities:
CONTEXT: Bone loss after bariatric surgery potentially could be mitigated by exercise. OBJECTIVE: To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss. DESIGN: Randomized, controlled trial. SETTING: Referral center for bariatric surgery. PATIENTS: Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB). INTERVENTION: Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only). OUTCOMES: Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes. RESULTS: Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium). CONCLUSION: Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.
Authors: Wagner S Dantas; Hamilton Roschel; Igor H Murai; Saulo Gil; Gangarao Davuluri; Christopher L Axelrod; Sujoy Ghosh; Susan S Newman; Hui Zhang; Samuel K Shinjo; Willian das Neves; Carlos Merege-Filho; Walcy R Teodoro; Vera L Capelozzi; Rosa Maria Pereira; Fabiana B Benatti; Ana L de Sá-Pinto; Roberto de Cleva; Marco A Santo; John P Kirwan; Bruno Gualano Journal: Diabetes Date: 2020-05-14 Impact factor: 9.461
Authors: Jill A Kanaley; Sheri R Colberg; Matthew H Corcoran; Steven K Malin; Nancy R Rodriguez; Carlos J Crespo; John P Kirwan; Juleen R Zierath Journal: Med Sci Sports Exerc Date: 2022-02-01 Impact factor: 5.411
Authors: Kristen M Beavers; Daniel P Beavers; Adolfo Z Fernandez; Katelyn A Greene; Ashlyn A Swafford; Ashley A Weaver; Sarah J Wherry; Jamy D Ard Journal: Clin Obes Date: 2021-09-27
Authors: Saulo Gil; Tiago Peçanha; Wagner S Dantas; Igor Hisashi Murai; Carlos Alberto Abujabra Merege-Filho; Ana Lúcia de Sá-Pinto; Rosa Maria Rodrigues Pereira; Roberto de Cleva; Marco Aurélio Santo; Diego Augusto Nunes Rezende; John P Kirwan; Bruno Gualano; Hamilton Roschel Journal: Obes Surg Date: 2020-10-27 Impact factor: 4.129