S1266 Roux-en-Y Gastric Bypass Is Associated With Worse Metabolic Bone Health Compared to Sleeve Gastrectomy: Propensity Matched Analysis of a Large Research Network

Background: While bariatric surgery could result in weight loss as well as glycaemia improvement, the short-term impact on bone health in a high glycemic environment following Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) remains intriguing. Objective: The aim of this study was to compare the short-term effects of RYGB and SG procedures on bone health in Zucker diabetic fatty (ZDFfa/fa) rats. Methods: Thirty age-matched male ZDFfa/fa rats were randomized into RYGB, SG, and sham groups after establishment of the diabetic model. Body weight, blood glucose, bone mineral density (BMD), the level of bone turnover markers (BTM), vitamin D, and serum calcium and phosphorus were measured 4 weeks after the operation. Results: The RYGB procedure brought about lower blood glucose, BMD, serum calcium and phosphorus levels, as well as a relatively higher bone turnover rate and 1,25(OH)2VD level, compared to the SG and sham groups, while the influences of the SG procedure were not significant. 25(OH)VD demonstrated no significant difference among the 3 groups. Conclusions: Despite its excellent ability to provide short-term glycemic control, the RYGB procedure could led to more severe impairment of bone health compared to the SG procedure. Bone health should be procured after bariatric surgery, especially with the RYGB procedure. Early detection of BMD and BTM may help to avoid deterioration of bone.

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Secondary Hyperparathyroidism, Bone Density and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.566 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A278-A279

Author(s):

Narriane Chaves Pereira Holanda ◽

Heloisa Calegari Borges ◽

Caio Chaves de Holanda Limeira ◽

Louise Raya Bezerra ◽

Silvane Katarine Medeiros Lima ◽

...

Keyword(s):

Weight Loss ◽

Gastric Bypass ◽

Sleeve Gastrectomy ◽

Bone Turnover ◽

Secondary Hyperparathyroidism ◽

Serum Calcium ◽

Bone Health ◽

Mineral Density ◽

Serum Leptin ◽

Time Of Surgery

Abstract Introduction: Although malabsorption of nutrients and changes in intestinal adipokines and gut hormones induced by Roux-en-Y gastric bypass (RYGB) are considerably different than sleeve gastrectomy (SG), little is known about the consequences on bone health resulted by these two procedures. Objective: to compare the prevalence of secondary hyperparathyroidism (SHPT), bone mineral density (BMD), bone turnover markers and serum leptin in obese patients undergoing RYGB and SG, according to the time of surgery and percent weight loss. Methods: we studied 117 patients (91% female, 51% RYGB, mean age 41.8 ± 6.7 years, mean time of surgery 4.3 ± 3.4 years) who were divided into two groups according to the surgical procedure adopted (SG vs. RYGB). They were evaluated at different times after surgery (1–2 years, > 2 and <5 years and ≥5 years) and according to the percentage of weight loss (10–20%, >20% and <40%, ≥40%). Anthropometric measurements, body composition and BMD, bone parameters (PTH, corrected serum calcium, 25OHD, alkaline phosphatase -AP, C-telopeptide - CTX), and biochemical tests were compared. Results: The prevalence of SHPT (PTH ≥ 65pg/ml) was 26%, higher in the RYGB vs. SG (35% vs. 17%, respectively, p = 0.039), despite no significant differences in serum 25OHD (28.5 ± 7.3 vs. 27.6 ± 7.7 ng/ml, p=0.519) and corrected serum calcium (9.8 ± 0.6 vs. 9.8 ± 0.5 mg/dl, p = 0.466) between the groups. Mean serum PTH, CTX and AP was higher in the RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/mL, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/mL; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/L, respectively). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. After 5 years of surgery, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151g/cm2, -8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267g/cm2, - 11.7%, p = 0.007). Mean serum leptin was lower in the RYGB group, when compared to SG (7.6 ± 5.8ng/mL vs. 14.0 ± 9.9, p = 0.001), with no correlation with BMD in any site. There were no significant differences between the RYGB and SG regarding the other metabolic parameters. Conclusion: We found a more deleterious effect of RYGB on bone health up to 5 years postoperatively in comparison with SG.

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Wirkmechanismen der bariatrischen und metabolen Chirurgie

Therapeutische Umschau ◽

10.1024/0040-5930/a001072 ◽

2019 ◽

Vol 76 (3) ◽

pp. 123-127

Author(s):

Hanna Hosa ◽

Marco Bueter

Keyword(s):

Gastric Bypass ◽

Sleeve Gastrectomy

Zusammenfassung. Zusammenfassung: Bei steigender Prävalenz der Adipositas und der damit assoziierten Komorbiditäten rückt die bariatrische und metabole Chirurgie immer mehr in den Vordergrund, wobei weltweit der Roux-Y-Magenbypass (= Roux-en-Y Gastric- Bypass, RYGB) und der Schlauchmagen (= Sleeve gastrectomy, SG) die häufigsten Eingriffe darstellen. Der erzielte Gewichtsverlust und das veränderte Essverhalten scheinen dabei nicht wie initial vermutet ausschliesslich auf einer mechanischen Restriktion der Nahrungspassage und / oder einer kalorischen Malabsorption der aufgenommenen Nahrung zu beruhen, sondern vielmehr auf ein komplexes Zusammenspiel verschiedenster physiologischer Wirkmechanismen zurückführbar zu sein. Ziel des vorliegenden Artikels ist es deshalb, vor dem Hintergrund des aktuellen Wissenstandes einen kurzen Überblick über die wichtigsten Wirkmechanismen der bariatrischen und metabolen Chirurgie zu liefern.

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