Bone Health After Bariatric Surgery

Dag Hofsø, Thor Olav Widerøe Hillestad, Erling Halvorsen, Farhat Fatima, Line Kristin Johnson, Morten Lindberg, Marius Svanevik, Rune Sandbu, Jøran Hjelmesæth
The Journal of Clinical Endocrinology & Metabolism, Volume 106, Issue 2, February 2021, Pages 501–511
https://doi.org/10.1210/clinem/dgaa808

Abstract

Context

Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with an increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health.

Objective

To compare changes in bone mineral density and markers of bone turnover 1 year after SG and RYGB.

Design, Setting, Patients, and Interventions

Randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB.

Main Outcome Measures

Changes in areal bone mineral density (aBMD) and bone turnover markers.

Results

Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n = 44) than after SG (n = 48) (mean [95% confidence interval] between group differences −2.8% [−4.7 to −0.8], −3.0% [−5.0 to −0.9], −4.2% [−6.4 to −2.1], and −0.5% [−1.6 to 0.6], respectively). The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG (between group difference at 1 year, both P < 0.001). The changes in femoral neck, total hip, and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P < 0.05) and not weight change.

Conclusions

Roux-en-Y gastric bypass was associated with a greater reduction in aBMD and a greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB.

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