Abstract
There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.
Highlights
Bariatric surgery has become an increasingly common treatment for severe obesity due to its outstanding results in long-term weight loss and sustained improvement in obesity-related comorbidities, mortality and quality of life [1,2]
Biochemical, and body composition characteristics were comparable between groups, except body mass index (BMI), which was higher in greater curvature plication (GCP) (Table 1)
As a summary of earlier published data [27,33], at year one, TWL% was significantly greater in the mRYGB group compared to sleeve gastrectomy (SG) and GCP
Summary
Bariatric surgery has become an increasingly common treatment for severe obesity due to its outstanding results in long-term weight loss and sustained improvement in obesity-related comorbidities, mortality and quality of life [1,2]. There is arising evidence of negative effects on bone health and risk of bone fractures at long-term in patients with surgically induced weight loss [3,4,5]. Patients with obesity and type 2 diabetes (T2D), before undergoing bariatric surgery, could have an increased risk of bone fracture. Contrary to what was believed, obese individuals usually have higher bone mineral density (BMD) compared to non-obese individuals [6,7], obesity per se is not protective and there is a site- and gender-specific relationship between body mass index (BMI) and fracture risk [8,9,10,11]. Individuals with T2D have normal or higher BMD in comparison with those without diabetes [12,13], but their bone quality is diminished and their risk of fracture is increased [14]. Patients with obesity and T2D whom undergo bariatric surgery meet many potentially deleterious factors on bone health that should be taken into consideration
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