Fernando Guerrero-Pérez1, Anna Casajoana2, Carmen Gómez-Vaquero3, Nuria Virgili1, Rafael López-Urdiales1, Laura Hernández-Montoliu1, Jordi Pujol-Gebelli2, Javier Osorio2, Carolina Alves4, Manuel Perez-Maraver1, Silvia Pellitero5,6, Anna Vidal-Alabró7, Sonia Fernández-Veledo6,8, Joan Vendrell9,10, Nuria Vilarrasa11,12. 1. Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. 2. Department of General and Gastrointestinal Surgery. Bariatric Surgery Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. 3. Department of Rheumatology, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. 4. Clinical Nutrition Unit, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. 5. Department of Endocrinology and Nutrition and Health Sciences Research Institute, University Hospital Germans Trias i Pujol, Badalona, Spain. 6. CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain. 7. Instituto de Investigación Biomédica-IDIBELL,, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. 8. Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain. 9. CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain. jvo@comt.es. 10. Diabetes and Metabolic Associated Diseases Research Group, Hospital Joan XXIII, School of Medicine, Rovira i Virgili University, Tarragona, Spain. jvo@comt.es. 11. Department of Endocrinology and Nutrition, Bellvitge University Hospital-IDIBELL, c/ Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. nuriavilarrasa@yahoo.es. 12. CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Barcelona, Spain. nuriavilarrasa@yahoo.es.
Abstract
BACKGROUND: To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. METHODS:Forty-five patients with T2D (mean BMI39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. RESULTS: After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. CONCLUSIONS: mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.
RCT Entities:
BACKGROUND: To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. METHODS: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. RESULTS: After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. CONCLUSIONS: mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.
Entities:
Keywords:
Bariatric surgery; Bone mineral density; Gastrointestinal hormones
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