Mohamed AbdAlla Salman1, Mohammed Aradaib2, Ahmed Salman3, Ahmed Elewa4, Mohamed Tourky5, Hossam El-Din Shaaban6. 1. General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. Mohammed.salman@kasralainy.edu.eg. 2. General Surgery Department, Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK. 3. Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt. 4. General Surgery Department Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt. 5. General Surgery Department, Great Western Hospital, NHS Foundation Trust, Swindon, UK. 6. Gastroenterology and Hepatology Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt.
Abstract
BACKGROUND: There is a growing interest in the post-operative bone-related effects of bariatric surgery. However, little is known about the comparative effects of the most commonly performed bariatric procedures, namely Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). OBJECTIVES: To systematically assess the differences in areal bone mineral density (aBMD) and biochemical and hormonal markers of bone metabolism among patients undergoing RYGB and SG. METHODS: We conducted a systematic review and meta-analysis of studies aBMD at different sites, as well as bone-specific alkaline phosphatase (BALP), 25-OH-vitamin D, calcium and parathyroid hormone (PTH) after RYGB and SG. RESULTS: Fourteen studies were included (717 patients, 50.63% in the RYGB arm). Based on data collected at 1 year, 2 years and > 2 years, there were no significant differences in aBMD measurements at the total hip, lumbar spine, femoral neck, and the whole body with no statistical heterogeneity among different comparisons. Patients in the RYGB group showed significantly higher concentrations of BALP at 1 year (SMD = 0.52, 95%CI, 0.23-0.81, p = 0.0004) and PTH at > 2 years of follow-up (SMD = 0.68, 95%CI, 0.31-1.05, p = 0.0003) compared to the SG group. CONCLUSION: There were no significant differences in aBMD measurements at the hip, lumbar spine, femoral neck, and the total body following RYGB and SG procedures. However, BALP and PTH concentrations were significantly higher after RYGB surgeries compared to SG. Attention should be paid to patients undergoing RYGB to prevent the expected skeletal fragility over time.
BACKGROUND: There is a growing interest in the post-operative bone-related effects of bariatric surgery. However, little is known about the comparative effects of the most commonly performed bariatric procedures, namely Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG). OBJECTIVES: To systematically assess the differences in areal bone mineral density (aBMD) and biochemical and hormonal markers of bone metabolism among patients undergoing RYGB and SG. METHODS: We conducted a systematic review and meta-analysis of studies aBMD at different sites, as well as bone-specific alkaline phosphatase (BALP), 25-OH-vitamin D, calcium and parathyroid hormone (PTH) after RYGB and SG. RESULTS: Fourteen studies were included (717 patients, 50.63% in the RYGB arm). Based on data collected at 1 year, 2 years and > 2 years, there were no significant differences in aBMD measurements at the total hip, lumbar spine, femoral neck, and the whole body with no statistical heterogeneity among different comparisons. Patients in the RYGB group showed significantly higher concentrations of BALP at 1 year (SMD = 0.52, 95%CI, 0.23-0.81, p = 0.0004) and PTH at > 2 years of follow-up (SMD = 0.68, 95%CI, 0.31-1.05, p = 0.0003) compared to the SG group. CONCLUSION: There were no significant differences in aBMD measurements at the hip, lumbar spine, femoral neck, and the total body following RYGB and SG procedures. However, BALP and PTH concentrations were significantly higher after RYGB surgeries compared to SG. Attention should be paid to patients undergoing RYGB to prevent the expected skeletal fragility over time.
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