Paul A Baldock1,2,3, Jacqueline R Center4,5,6,7, Malgorzata M Brzozowska1,8,2, Thach Tran1,2, Dana Bliuc1,2, John Jorgensen9, Michael Talbot2,9, Douglas Fenton-Lee10, Weiwen Chen1, Angel Hong11, Alex Viardot1,2,12, Chris P White2,11,13, Tuan V Nguyen1,2,3,14, Nicholas Pocock2,15, John A Eisman1,2,3,16. 1. Osteoporosis and Bone Biology Division, Garvan institute of Medical Research, Sydney, NSW, Australia. 2. University of New South Wales Sydney, Faculty of Medicine, Sydney, NSW, Australia. 3. University of Notre Dame Australia, School of Medicine Sydney, Sydney, NSW, Australia. 4. Osteoporosis and Bone Biology Division, Garvan institute of Medical Research, Sydney, NSW, Australia. j.center@garvan.org.au. 5. University of New South Wales Sydney, Faculty of Medicine, Sydney, NSW, Australia. j.center@garvan.org.au. 6. University of Notre Dame Australia, School of Medicine Sydney, Sydney, NSW, Australia. j.center@garvan.org.au. 7. Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia. j.center@garvan.org.au. 8. Sutherland and St George Hospitals, Sydney, NSW, Australia. 9. St George Private Hospital, Sydney, NSW, Australia. 10. St Vincent's Private Hospital, Sydney, NSW, Australia. 11. Clinical Chemistry & Endocrinology, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia. 12. Department of Endocrinology, St Vincent's Hospital Clinical School, Sydney, NSW, Australia. 13. Department of Endocrinology and Metabolism, Prince of Wales Hospital, Sydney, NSW, Australia. 14. University of Technology Sydney, Sydney, NSW, Australia. 15. Department of Nuclear Medicine, St Vincent's Hospital, Sydney, NSW, Australia. 16. Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.
Abstract
OBJECTIVES: Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months. METHODS: Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study. RESULTS: All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB -14% (95% CI: -12, -17) and GS -9% (95% CI: -7, -10). In RYGB forearm BMD also declined over 36 months -9% (95% CI: -6, -12) and LS BMD declined over the first 12 months -7% (95% CI: -3, -12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants. CONCLUSIONS: RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.
OBJECTIVES: Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months. METHODS: Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study. RESULTS: All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB -14% (95% CI: -12, -17) and GS -9% (95% CI: -7, -10). In RYGB forearm BMD also declined over 36 months -9% (95% CI: -6, -12) and LS BMD declined over the first 12 months -7% (95% CI: -3, -12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants. CONCLUSIONS: RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.
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