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Parathyroid Hormone and Bone Marker Levels in Patients with Morbid Obesity Before and After Biliopancreatic Diversion

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Background

Scopinaro biliopancreatic diversion (BPD) is associated with malabsorption of calcium and vitamin D, which manifests as a secondary hyperparathyroidism (SHP) and may lead to osteopenia.

Methods

96 morbidly obese patients were studied (age 19–60 years, 23 men and 73 women, with mean initial BMI 53) following intervention by Scopinaro BPD. The change in iPTH levels, urine DPD, Pyrilinks-D of DPC and serum CTx were studied at 0, 3, 6, 12, 18 and 24 months after surgery. Postoperatively, they were given supplements of calcium and vitamin D3. The control group consisted of 67 non-obese women and 10 men.

Results

The iPTH levels gradually increased after BPD, with a substantial difference compared to presurgery levels at month 6. In spite of the calcium and vitamin D supplements, 77% of the patients with presurgery SHP did maintain high levels of iPTH after 2 years.The percentage of SHP among the patients with normal pre-surgery iPTH was 58%. The basal figures of DPD/cre were significantly higher than in the control group, 9.06 (4.6–13.5) nM/mMcre vs 3.9 (2.8–5.6) in men and 6.75 (5.4–7.9) vs 7.67 (3.3–11.6) in women, but not CTx, 0.24 (0.02–0.89) vs 0.22 (0.07–0.55). After the operation, there was a noticeable increase which persisted at 2 years. There was a lack of correlation between the levels of iPTH and the bone resorption markers, i.e. the first ones decreased from month 6 in men and from month 12 in women, while the levels of iPTH continued to increase.

Conclusion

In obese patients, we found no correlation between iPTH levels and BMI. Supplements of calcium and vitamin D did not prevent the appearance of SHP following BPD. The patients with high pre-surgery iPTH levels have a higher risk of malabsorption of calcium and vitamin D. Following malabsorptive bariatric surgery, there is an increase in bone resorption, which results in DPD and CTx increase. Those markers do not correlate with iPTH, and this may suggest that there is a phenomenon of bone reshaping parallel to the loss of weight.

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References

  1. Otrowska Z, Zwirska-Korczala K, Buntner B et al. Assessment of bone metabolism in obese women. Endocr Regul 1998; 32: 177–81.

    Google Scholar 

  2. Hey H, Stokholm KH, Lund B et al. Vitamin D deficiency in obese patients and changes in circulating vitamin D metabolites following jejunoileal bypass. Int J Obes 1982; 6: 473–9.

    PubMed  CAS  Google Scholar 

  3. Wortsman J, Matsuoka LY, Chen TC et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2003; 72: 690–3.

    Google Scholar 

  4. Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg 2004; 14: 9–12.

    Article  PubMed  Google Scholar 

  5. Kamycheva E, Sundsfjord J, Jorde R. Serum parathyroid hormone level is associated with body mass index. Eur J Endocrinol 2005; 151: 167–72.

    Article  Google Scholar 

  6. Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004; 14: 1157–64.

    Article  PubMed  Google Scholar 

  7. 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: 48–55.

    Article  PubMed  Google Scholar 

  8. Goldner WS, O’Dorisio TM, Dillon JS et al. Severe metabolic bone disease as a long-term complication of obesity surgery. Obes Surg 2002; 12: 685–92.

    Article  PubMed  Google Scholar 

  9. Hamoui N, Kim K, Anthone G et al. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg 2003; 138: 891–7.

    Article  PubMed  CAS  Google Scholar 

  10. De Prisco C, Levine SN. Metabolic bone disease after gastric bypass surgery for obesity. Am J Med Sci 2005; 329: 57–61.

    Article  PubMed  Google Scholar 

  11. Fujioka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care 2005; 28: 481–4.

    Article  PubMed  Google Scholar 

  12. Chapin BL, LeMar HJJ, Knodel DH et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg 1996; 131: 1048–52.

    PubMed  CAS  Google Scholar 

  13. Sahota O, Masud T, San P et al. Vitamin D insufficiency increases bone turnover markers and enhances bone loss at the hip in patients with established vertebral osteoporosis. Clin Endocrinol 1999; 51: 217–21.

    Article  CAS  Google Scholar 

  14. Bloomberg RD, Fleishman A, Nalle JE et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005; 15: 145–54.

    Article  PubMed  Google Scholar 

  15. Marceau P, Biron S, Lebel S et al. Does bone change after biliopancreatic diversion? J Gastrointest Surg 2002; 6: 690–8.

    Article  PubMed  Google Scholar 

  16. Scopinaro N. Laparoscopic BPD (commentary). Obes Surg 2000; 10: 524.

    Article  PubMed  Google Scholar 

  17. Scopinaro N, Marinari GM, Camerini G. Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg 2002; 12: 241–4.

    Article  PubMed  Google Scholar 

  18. Christenson RH. Biochemical markers of bone metabolism: an overview. Clin Biochem 1997; 30: 573–93.

    Article  PubMed  CAS  Google Scholar 

  19. Price C, Thompson P. The role of biochemistry test in the screening and monitoring of osteoporosis. Ann Clin Biochem 1995; 32: 244–60.

    PubMed  CAS  Google Scholar 

  20. Demers L. Clinical usefulness of markers of bone degradation and formation. Scand J Clin Lab Invest 1997; 57: 12–20.

    Article  Google Scholar 

  21. Panteghini M, Pagani F. Biological variation in urinary excretion of pyridinium crosslinks: recommendations for the optimum specimen. Ann Clin Biochem 1996; 33: 36–42.

    PubMed  Google Scholar 

  22. Gundarmann KD. Bioluminescence and Chemiluminescence – Basic Chemistry and Analytical Applications. New York: Academic Press, 1981: 17–9.

    Google Scholar 

  23. Wood WG. Luminescence immunoassays. J Clin Chem Clin Biochem 1984; 22: 905–18.

    PubMed  CAS  Google Scholar 

  24. Bell NH, Epstein S, Greene A et al. Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 1985; 76: 370–3.

    Article  PubMed  CAS  Google Scholar 

  25. Jorde R, Bonaa KH, Sundsfjord J et al. Population based study on serum ionised calcium, serum parathyroid hormone, and blood pressure. The Tromso study. Eur J Endocrinol 1999; 141: 350–7.

    Article  PubMed  CAS  Google Scholar 

  26. Cundy T, Evans MC, Kay R et al. Effects of vertical banded gastroplasty on bone and mineral metabolism in obese patients. Br J Surg 1996; 83: 1468–72.

    Article  PubMed  CAS  Google Scholar 

  27. Pugnale N, Giusti V, Suter M et al. Bone metabolism and risk of secondary hyperparathyroidism months after gastric banding in obese pre-menopausal women. Int J Obes 2003; 27: 110–6.

    Article  CAS  Google Scholar 

  28. Shaker JL, Norton AJ, Woods MF et al. Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity. Osteoporos Int 1991; 1: 177–81.

    Article  PubMed  CAS  Google Scholar 

  29. Diniz M de F, Diniz MT, Sanches SR et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg 2004; 14: 1222–6.

    Article  PubMed  Google Scholar 

  30. Newbury L, Dolan K, Hatifotis M et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg 2003; 13: 893–5.

    Article  PubMed  Google Scholar 

  31. Goode LR, Brolin RE, Chowdhury HA et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Surg 2004; 12: 40–7.

    CAS  Google Scholar 

  32. Coates PS, Fernstrom JD, Fernstrom MH et al. Gastric bypass surgery for morbid obesity leads to an increase of bone turnover and a decrease in bone mass. J Clin Endocrinol Metab 2004; 89: 1059–60.

    Article  CAS  Google Scholar 

  33. Guney E, Kisakol G, Ozgen G et al. Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg 2003; 13: 383–8.

    Article  PubMed  Google Scholar 

  34. Bowen J, Noakes M, Clifton PM. A high dairy protein, high-calcium diet minimizes bone turnover in overweight adults during weight loss. J Nutr 2004; 134: 568–73.

    PubMed  CAS  Google Scholar 

  35. Worsfold M, Powell DE, Jones T et al. Assessment of urinary bone markers for monitoring treatment of osteoporosis. Clin Chem 2004; 50: 2263–70.

    Article  PubMed  CAS  Google Scholar 

  36. Von Mach MA, Stoeckli R, Kraenzlin M et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism 2004; 53: 918–21.

    Article  CAS  Google Scholar 

  37. Shapses SA, Von Thun NL, Heymsfield SB et al. Bone turnover and density in obese pre-menopausal women during moderate weight loss and calcium supplementation. J Bone Miner Res 2001; 16: 1329–36.

    Article  PubMed  CAS  Google Scholar 

  38. Okabe R, Inaba M, Nakatsuka K et al. Significance of serum CrossLap as a predictor of changes in bone mineral density during estrogen replacement therapy; comparison with serum carboxyterminal telopeptide of type I collagen and urinary deoxypyridinoline. J Bone Miner Metab 2004; 22: 127–31.

    Article  PubMed  CAS  Google Scholar 

  39. Huber F, Traber L, Roth H et al. Markers of bone resorption-measurement in serum, plasma or urine. Clin Lab 2003; 49 (5–6): 203–7.

    PubMed  CAS  Google Scholar 

  40. Peichl P, Griesmacherb A, Marteau R et al. Serum Crosslaps in comparison to serum osteocalcin and urinary bone resorption markers. Clin Biochem 2001; 34: 131–4.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Endocrinology and Nutrition, University Hospital Son Duerta, C/. Luis Vives, 1 4° A. 07003, Palma de Mallorca, Balearic Islands, Spain

    J. Moreiro & J. R. Urgeles

  2. Clinical Analysis, University Hospital of Son Dureta, Palma de Mallorca, Balearic Islands, Spain

    O. Ruiz, G. Perez & M. Riesco

  3. Surgery, University Hospital of Son Dureta, Palma de Mallorca, Balearic Islands, Spain

    R. Salinas & M. García-Sanz

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  1. J. Moreiro
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  2. O. Ruiz
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  3. G. Perez
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  4. R. Salinas
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  5. J. R. Urgeles
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Correspondence to J. Moreiro.

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Moreiro, J., Ruiz, O., Perez, G. et al. Parathyroid Hormone and Bone Marker Levels in Patients with Morbid Obesity Before and After Biliopancreatic Diversion. OBES SURG 17, 348–354 (2007). https://doi.org/10.1007/s11695-007-9063-9

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  • DOI: https://doi.org/10.1007/s11695-007-9063-9

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