Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 1/2016

01-01-2016 | Original Contributions

Changes in Bone Metabolism in Morbidly Obese Patients After Bariatric Surgery: A Meta-Analysis

Authors: Cong Liu, Dan Wu, Jing-Fan Zhang, Duo Xu, Wan-Feng Xu, Yu Chen, Bing-Yang Liu, Ping Li, Ling Li

Published in: Obesity Surgery | Issue 1/2016

Login to get access

Abstract

Background

The aim is to evaluate via meta-analysis bone metabolism and bone mineral density (BMD) in morbidly obese patients before and after bariatric surgery.

Methods

We searched Medline, EMBASE, and the Cochrane Library for relevant studies published before January 2014. The following outcomes were evaluated: serum calcium, serum parathyroid hormone (PTH), serum 25-hydroxyvitamin D [25(OH)D], serum or urinary N-telopeptide (NTX), bone-specific alkaline phosphatase (BSAP), and bone mineral density (BMD).

Results

Ten studies, including 344 patients, met our inclusion criteria. Results showed a significant decrease in serum calcium (MD = −0.10, 95 %CI −0.14 to −0.07, P < 0.00001) and increase in serum PTH (MD = 12.41, 95 %CI 6.51 to 18.31, P < 0.00001) but no significant difference in serum 25(OH)D (MD = 1.35, 95 %CI −1.12 to 3.83, P = 0.28) following bariatric surgery. There were significant increases in serum or urinary NTX (MD = 18.49, 95 %CI 3.33 to 33.66, P = 0.02) and BSAP (MD = 7.47, 95 %CI 0.21 to 14.72, P = 0.04) but a significant decrease in BMD (MD = −0.08, 95 %CI −0.13 to −0.04, P < 0.00001) after bariatric surgery.

Conclusion

BMD was significantly decreased, while bone turnover was elevated, and bone remodeling was accelerated following bariatric surgery. Basal bone metabolism should be evaluated preoperatively. To prevent secondary hyperparathyroidism and bone loss, calcium and vitamin D should be monitored closely and supplemented accordingly after the surgery.
Literature
1.
Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.PubMedCrossRef
2.
de la Cruz-Muñoz N, Messiah SE, Arheart KL, et al. Bariatric surgery significantly decreases the prevalence of type 2 diabetes mellitus and pre-diabetes among morbidly obese multiethnic adults: long-term results. J Am Coll Surg. 2011;212(4):505–13.PubMedCrossRef
3.
Gurevich-Panigrahi T, Panigrahi S, Wiechec E, et al. Obesity: pathophysiology and clinical management. Curr Med Chem. 2009;16(4):506–21.PubMedCrossRef
4.
Iyengar NM, Hudis CA, Dannenberg AJ. Obesity and cancer: local and systemic mechanisms. Annu Rev Med. 2015;66:297–309.PubMedCrossRef
5.
Apovian CM. The clinical and economic consequences of obesity. Am J Manag Care. 2013;19(11 Suppl):s219–28.
6.
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ. 2014;349:g3961.PubMedCrossRef
7.
Rodríguez-Carmona Y, López-Alavez FJ, González-Garay AG, et al. Bone mineral density after bariatric surgery. A systematic review. Int J Surg. 2014;12(9):976–82.PubMedCrossRef
8.
Al-Shoha A, Qiu S, Palnitkar S, et al. Osteomalacia with bone marrow fibrosis due to severe vitamin D deficiency after a gastrointestinal bypass operation for severe obesity. Endocr Pract. 2009;15(6):528–33.PubMedCrossRef
9.
Zittel TT, Zeeb B, Maier GW, et al. High prevalence of bone disorders after gastrectomy. Am J Surg. 1997;174(4):431–8.PubMedCrossRef
10.
Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.PubMedCrossRef
11.
Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89(3):1061–5.PubMedCrossRef
12.
El-Kadre LJ, Rocha PR, de Almeida Tinoco AC, et al. Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14(8):1062–6.PubMedCrossRef
13.
Goode LR, Brolin RE, Chowdhury HA, et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12(1):40–7.PubMedCrossRef
14.
Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring). 2006;14(11):1940–8.CrossRef
15.
Fleischer J, Stein EM, Bessler M, et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008;93(10):3735–40.PubMedPubMedCentralCrossRef
16.
Mahdy T, Atia S, Farid M, et al. Effect of Roux-en Y gastric bypass on bone metabolism in patients with morbid obesity: Mansoura experiences. Obes Surg. 2008;18(12):1526–31.PubMedCrossRef
17.
Carrasco F, Ruz M, Rojas P, et al. Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery. Obes Surg. 2009;19(1):41–6.PubMedCrossRef
18.
Bruno C, Fulford AD, Potts JR, et al. Serum markers of bone turnover are increased at six and 18 months after Roux-en-Y bariatric surgery: correlation with the reduction in leptin. J Clin Endocrinol Metab. 2010;95(1):159–66.PubMedPubMedCentralCrossRef
19.
Vilarrasa N, San José P, García I, et al. Evaluation of bone mineral density loss in morbidly obese women after gastric bypass: 3-year follow-up. Obes Surg. 2011;21(4):465–72.PubMedCrossRef
20.
Casagrande DS, Repetto G, Mottin CC, et al. Changes in bone mineral density in women following 1-year gastric bypass surgery. Obes Surg. 2012;22(8):1287–92.PubMedCrossRef
21.
Bose M, Teixeira J, Olivan B, et al. Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery. J Diabetes. 2010;2(1):47–55.PubMedCrossRef
22.
23.
Vilarrasa N, Gómez JM, Elio I, et al. Evaluation of bone disease in morbidly obese women after gastric bypass and risk factors implicated in bone loss. Obes Surg. 2009;19(7):860–6.PubMedCrossRef
24.
Valderas JP, Velasco S, Solari S, et al. Increase of bone resorption and the parathyroid hormone in postmenopausal women in the long-term after Roux-en-Y gastric bypass. Obes Surg. 2009;19(8):1132–8.PubMedCrossRef
25.
Ott MT, Fanti P, Malluche HH, et al. Biochemical evidence of metabolic bone disease in women following Roux-Y gastric bypass for morbid obesity. Obes Surg. 1992;2(4):341–8.PubMedCrossRef
26.
Collazo-Clavell ML, Jimenez A, Hodgson SF, et al. Osteomalacia after Roux-en-Y gastric bypass. Endocr Pract. 2004;10(3):195–8.PubMedCrossRef
27.
Ricci TA, Chowdhury HA, Heymsfield SB, et al. Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. J Bone Miner Res. 1998;13(6):1045–50.PubMedCrossRef
28.
29.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRef
30.
31.
Blackburn GL. Solutions in weight control: lessons from gastric surgery. Am J Clin Nutr. 2005;82(1 Suppl):248S–52.PubMed
32.
Oliván B, Teixeira J, Bose M, et al. Effect of weight loss by diet or gastric bypass surgery on peptide YY3-36 levels. Ann Surg. 2009;249(6):948–53.PubMedPubMedCentralCrossRef
33.
Canales BK, Schafer AL, Shoback DM, et al. Gastric bypass in obese rats causes bone loss, vitamin D deficiency, metabolic acidosis, and elevated peptide YY. Surg Obes Relat Dis. 2014;10(5):878–84.PubMedPubMedCentralCrossRef
34.
Al-Rasheid N, Gray R, Sufi P, et al. Chronic elevation of systemic glucagon-like peptide-1 following surgical weight loss: association with nausea and vomiting and effects on adipokines. Obes Surg. 2015;25(2):386–91.PubMedPubMedCentralCrossRef
35.
Yang J, Feng X, Zhong S, et al. Gastric bypass surgery may improve beta cell apoptosis with ghrelin overexpression in patients with BMI ≥ 32.5 kg/m(2.). Obes Surg. 2014;24(4):561–71.PubMedCrossRef
36.
Chen J, Pamuklar Z, Spagnoli A, et al. Serum leptin levels are inversely correlated with omental gene expression of adiponectin and markedly decreased after gastric bypass surgery. Surg Endosc. 2012;26(5):1476–80.PubMedPubMedCentralCrossRef
37.
von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53(7):918–21.CrossRef
38.
Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8(1):48–55.PubMedCrossRef
39.
Bal B, Koch TR, Finelli FC, et al. Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery. Nat Rev Gastroenterol Hepatol. 2010;7(6):320–34.PubMed
40.
Heber D, Greenway FL, Kaplan LM, et al. Endocrine and nutritional management of the post-bariatric surgery patient: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2010;95(11):4823–43.PubMedCrossRef
41.
42.
Khandalavala BN, Hibma PP, Fang X. Prevalence and persistence of vitamin D deficiency in biliopancreatic diversion patients: a retrospective study. Obes Surg. 2010;20(7):881–4.PubMedCrossRef
43.
44.
Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.PubMedCrossRef
45.
Scibora LM, Ikramuddin S, Buchwald H, et al. Examining the link between bariatric surgery, bone loss, and osteoporosis: a review of bone density studies. Obes Surg. 2012;22(4):654–67.PubMedCrossRef
46.
Johnson JM, Maher JW, Samuel I, et al. Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J Gastrointest Surg. 2005;9(8):1106–11.PubMedCrossRef
47.
Yu EW, Bouxsein ML, Roy AE, et al. Bone loss after bariatric surgery: discordant results between DXA and QCT bone density. J Bone Miner Res. 2014;29(3):542–50.PubMedPubMedCentralCrossRef
48.
49.
Metadata
Title
Changes in Bone Metabolism in Morbidly Obese Patients After Bariatric Surgery: A Meta-Analysis
Authors
Cong Liu
Dan Wu
Jing-Fan Zhang
Duo Xu
Wan-Feng Xu
Yu Chen
Bing-Yang Liu
Ping Li
Ling Li
Publication date
01-01-2016
Publisher
Springer US
Published in
Obesity Surgery / Issue 1/2016
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1724-5

Other articles of this Issue 1/2016

Obesity Surgery 1/2016 Go to the issue

Review Article

Analysis of the Information Quality of Bariatric Surgery Smartphone Applications Using the Silberg Scale

New Concept

Minimizing the Access Trauma of Laparoscopic Sleeve Gastrectomy: the Transoral Specimen Extraction Technique

Original Contributions

Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?

Original Contributions

Following Bariatric Surgery: an Exploration of the Couples’ Experience

Video Submission

Laparoscopic Undo of Fundoplication with Roux-en-Y Gastric Bypass in a Morbidly Obese Patient with Prior Nissen’s Fundoplication: A Video Report

Original Contributions

Effects of Fat and Protein Preloads on Pouch Emptying, Intestinal Transit, Glycaemia, Gut Hormones, Glucose Absorption, Blood Pressure and Gastrointestinal Symptoms After Roux-en-Y Gastric Bypass