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Bariatric Surgery

Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss

International Journal of Obesity volume 45, pages 235–246 (2021)Cite this article

Subjects

Abstract

Objectives

Little is known about the long-term skeletal impact of bariatric procedures, particularly the increasingly commonly performed gastric sleeve surgery (GS). We examined bone density (BMD) change following three types of bariatric surgery Roux-en-Y gastric bypass (RYGB), GS and laparoscopic adjustable gastric banding (LAGB), compared with diet, over 36 months.

Methods

Non-randomized, prospective study of participants with severe obesity (n = 52), undergoing weight-loss interventions: RYGB (n = 7), GS (n = 21), LAGB (n = 11) and diet (n = 13). Measurements of calciotropic indices, gut hormones (fasting and post prandial) peptide YY (PYY), glucagon-like peptide 1 (GLP1) and adiponectin together with dual-X-ray absorptiometry and quantitative computed tomography scans were performed thorough the study.

Results

All groups lost weight during the first 12 months. Despite weight stability from 12 to 36 months and supplementation of calcium and vitamin D, there was progressive bone loss at the total hip (TH) over 36 months in RYGB −14% (95% CI: −12, −17) and GS −9% (95% CI: −7, −10). In RYGB forearm BMD also declined over 36 months −9% (95% CI: −6, −12) and LS BMD declined over the first 12 months −7% (95% CI: −3, −12). RYGB and GS groups experienced significantly greater bone loss until 36 months than LAGB and diet groups, which experienced no significant BMD loss. These bone losses remained significant after adjustment for weight loss and age. RYGB and GS procedures resulted in elevated postprandial PYY, adiponectin and bone turnover markers up to 36 months without such changes among LAGB and diet participants.

Conclusions

RYGB and GS but not LAGB resulted in ongoing TH bone loss for three postoperative years. For RYGB, bone loss was also observed at LS and non-weight-bearing forearms. These BMD changes were independent of weight and age differences. We, therefore, recommend close monitoring of bone health following RYGB and GS surgeries.

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Fig. 1: Weight and body composition changes after weight loss procedures.
Fig. 2: Bone mineral density changes following weight loss procedures.
Fig. 3: Changes in hormones and bone turnover markers following weight loss procedures.

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Acknowledgements

The authors thank the nurses of the Clinical Research Facility, including Srs Lynne Schofield, Vanessa Travers and Ashley Douglas and all the volunteers who participated in the study.

Funding

National Health and Medical Research Council (NHMRC) Scholarship for MMB.

Author information

Author notes

  1. These authors contributed equally: Paul A. Baldock, Jacqueline R. Center

Authors and Affiliations

  1. Osteoporosis and Bone Biology Division, Garvan institute of Medical Research, Sydney, NSW, Australia

    Malgorzata M. Brzozowska, Thach Tran, Dana Bliuc, Weiwen Chen, Alex Viardot, Tuan V. Nguyen, John A. Eisman, Paul A. Baldock & Jacqueline R. Center

  2. Sutherland and St George Hospitals, Sydney, NSW, Australia

    Malgorzata M. Brzozowska

  3. University of New South Wales Sydney, Faculty of Medicine, Sydney, NSW, Australia

    Malgorzata M. Brzozowska, Thach Tran, Dana Bliuc, Michael Talbot, Alex Viardot, Chris P. White, Tuan V. Nguyen, Nicholas Pocock, John A. Eisman, Paul A. Baldock & Jacqueline R. Center

  4. St George Private Hospital, Sydney, NSW, Australia

    John Jorgensen & Michael Talbot

  5. St Vincent’s Private Hospital, Sydney, NSW, Australia

    Douglas Fenton-Lee

  6. Clinical Chemistry & Endocrinology, NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia

    Angel Hong & Chris P. White

  7. Department of Endocrinology, St Vincent’s Hospital Clinical School, Sydney, NSW, Australia

    Alex Viardot

  8. Department of Endocrinology and Metabolism, Prince of Wales Hospital, Sydney, NSW, Australia

    Chris P. White

  9. University of Notre Dame Australia, School of Medicine Sydney, Sydney, NSW, Australia

    Tuan V. Nguyen, John A. Eisman, Paul A. Baldock & Jacqueline R. Center

  10. University of Technology Sydney, Sydney, NSW, Australia

    Tuan V. Nguyen

  11. Department of Nuclear Medicine, St Vincent’s Hospital, Sydney, NSW, Australia

    Nicholas Pocock

  12. Department of Endocrinology, St Vincent’s Hospital, Sydney, NSW, Australia

    John A. Eisman & Jacqueline R. Center

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  1. Malgorzata M. Brzozowska
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Contributions

Study design: JRC, PAB, MMB, JAE, NP, CPW, JJ, MT, DFL. Study conduct: MMB. Data collection: MMB, CPW, JJ, MT, DFL, AH. Data analysis: TT, JRC, DB, MMB, CPW, WC, TVN. Data interpretation: TT, JRC, MMB, PAB, DB, JAE, TVN, CPW, AH. Drafting manuscript: M.B. Revising manuscript content: MMB, JRC, TT, CPW, PAB, JAE. Approving final version of manuscript: all authors. JRC and TT take responsibility for the integrity of the data analysis.

Corresponding author

Correspondence to Jacqueline R. Center.

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Conflict of interest

TT, DB, WC, AH, TVN and PAB have no competing of interests to report. MMB, JJ, AV, CPW, NP, DF-L, JAE and JRC disclosed relevant financial interests outside this body of work. MMB has received a honorarium for educational talk from Astra Zeneca. JJ has received honorarium for educational talk from GORE company. MT has received consulting support from Gore, Medtronic, Ethicon Endosurgery, Olympus and MSD. AV has received a honorarium for educational talk from Astra Zeneca. CPW received consulting and research support from Amgen. N.P received consulting and research support from Amgen. DF-L received consulting support from Medtronic. JRC has received honoraria for educational talks and/or been on Advisory boards from Amgen and Theramex/Teva. JAE received consulting and research support from Amgen, Eli Lilly, Merck Sharp and Dohme and Novartis. This does not alter our adherence to JBMR policies on sharing data and materials.

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Brzozowska, M.M., Tran, T., Bliuc, D. et al. Roux-en-Y gastric bypass and gastric sleeve surgery result in long term bone loss. Int J Obes 45, 235–246 (2021). https://doi.org/10.1038/s41366-020-00660-x

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