Skip to main content
Erschienen in: Obesity Surgery 11/2009

01.11.2009 | Physiology Research

Bone Mass Decreases in Morbidly Obese Women after Long Limb-Biliopancreatic Diversion and Marked Weight Loss Without Secondary Hyperparathyroidism. A Physiological Adaptation to Weight Loss?

verfasst von: Dimitrios D. A. Tsiftsis, Panagiotis Mylonas, Nancy Mead, Fotis Kalfarentzos, Theodore K. Alexandrides

Erschienen in: Obesity Surgery | Ausgabe 11/2009

Einloggen, um Zugang zu erhalten

Abstract

Objective

To investigate the effect of marked weight loss after long limb-biliopancreatic diversion (BPD-LL) on bone mass and serum calcium, 25-OH-vitamin D, and PTH levels in relation to calcium supplementation.

Background Data

BPD is the most effective type of bariatric surgery, but it is followed by bone mass loss, mainly attributed to calcium and vitamin D malabsorption leading to secondary hyperparathyroidism.

Methods

Two groups, each consisting of 26 healthy, morbidly obese, premenopausal women, underwent BPD-LL. Both groups received high-calcium diets, 200 IU of vitamin D and 100 mg elemental calcium daily and group B, in addition to an extra 2 g of calcium. Bone density and biochemical markers were measured before and 12 months after BPD-LL.

Results

One year after surgery, both groups had lost an average of 55 kg of body weight; albumin-corrected calcium concentration did not change. 25-OH-vitamin D levels in group A were 17.34 ± 8.90 pre- and 20.51 ± 14.71 μg/L postoperatively (p = 0.058), and in group B, 15.70 ± 9.46 and 13.52 ± 8.16 μg/L (p = 0.489), respectively. PTH levels in group A were 38.5 ± 12.2 before and 51.2 ± 32.8 pg/ml after surgery (p = 0.08), and in group B, 48.1 ± 26.3 and 52.9 ± 29.2 pg/ml (p = 0.147), respectively. Bone formation markers (alkaline phosphatase, osteocalcin and procollagen type 1), as well as the bone resorption marker CTx, increased significantly in both groups. Bone mineral density T score was 0.862 ± 0.988 in group A and 0.851 ± 1.44 in group B and declined postoperatively to −0.123 ± 1.082 and 0.181 ± 1.285, respectively.

Conclusions

Marked weight loss after BPD-LL leads to increased bone turnover and normalization of the increased bone mass without calcium or vitamin D malabsorption and without the appearance of secondary hyperparathyroidism. We conclude that the bone mass reduction is a normal adaptation to the decreased loading of the bone following weight loss.
Literatur
1.
Zurück zum Zitat Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRef Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRef
2.
Zurück zum Zitat Mason ME, Jalagani H, Vinik A. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34:25–33.CrossRef Mason ME, Jalagani H, Vinik A. Metabolic complications of bariatric surgery: diagnosis and management issues. Gastroenterol Clin North Am. 2005;34:25–33.CrossRef
3.
Zurück zum Zitat Compston JRE, Vedi S, Ledger JE, et al. Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr. 1981;34:2359–63.CrossRef Compston JRE, Vedi S, Ledger JE, et al. Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr. 1981;34:2359–63.CrossRef
4.
Zurück zum Zitat 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;2:341–8.CrossRef 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;2:341–8.CrossRef
5.
Zurück zum Zitat Chapin BL, LeMar HJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;13:1048–52.CrossRef Chapin BL, LeMar HJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;13:1048–52.CrossRef
6.
Zurück zum Zitat Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following bilopancreatic diversion. Obes Surg. 2003;13:893–5.CrossRef Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following bilopancreatic diversion. Obes Surg. 2003;13:893–5.CrossRef
7.
Zurück zum Zitat Pugnale N, Giusti V, Suter M, et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes Relat Metab Disord. 2003;27:110–6.CrossRef Pugnale N, Giusti V, Suter M, et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes Relat Metab Disord. 2003;27:110–6.CrossRef
8.
Zurück zum Zitat 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.CrossRef 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.CrossRef
9.
Zurück zum Zitat Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.CrossRef Bloomberg RD, Fleishman A, Nalle JE, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.CrossRef
10.
Zurück zum Zitat Avgerinos DV, Leitman IM, Martínez RE, et al. J Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass operations. Am Coll Surg. 2007;205:294–7.CrossRef Avgerinos DV, Leitman IM, Martínez RE, et al. J Evaluation of markers for calcium homeostasis in a population of obese adults undergoing gastric bypass operations. Am Coll Surg. 2007;205:294–7.CrossRef
11.
Zurück zum Zitat Jin J, Robinson A, Hallowell P, et al. Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery. 2007;142:914–20.CrossRef Jin J, Robinson A, Hallowell P, et al. Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery. 2007;142:914–20.CrossRef
12.
Zurück zum Zitat Marceau P, Biron S, Lebel S, et al. Does bone change after biliopancreatic diversion? J Gastrointest Surg. 2002;6:690–8.CrossRef Marceau P, Biron S, Lebel S, et al. Does bone change after biliopancreatic diversion? J Gastrointest Surg. 2002;6:690–8.CrossRef
13.
Zurück zum Zitat Abbasi AA, Amin M, Smiertka JK, et al. Abnormalities of vitamin D and calcium metabolism after surgical treatment of morbid obesity: a study of 136 patients. Endocr Pract. 2007;13:131–6.CrossRef Abbasi AA, Amin M, Smiertka JK, et al. Abnormalities of vitamin D and calcium metabolism after surgical treatment of morbid obesity: a study of 136 patients. Endocr Pract. 2007;13:131–6.CrossRef
14.
Zurück zum Zitat 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. 2007;17:348–54.CrossRef 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. 2007;17:348–54.CrossRef
15.
Zurück zum Zitat Youssef Y, Richards WO, Sekhar N, et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc. 2007;21:1393–6.CrossRef Youssef Y, Richards WO, Sekhar N, et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc. 2007;21:1393–6.CrossRef
16.
Zurück zum Zitat Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity. 2006;14:1940–8.CrossRef Riedt CS, Brolin RE, Sherrell RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity. 2006;14:1940–8.CrossRef
17.
Zurück zum Zitat Olmos JM, Vázquez LA, Amado JA, et al. Mineral metabolism in obese patients following vertical banded gastroplasty. Obes Surg. 2008;18:197–203.CrossRef Olmos JM, Vázquez LA, Amado JA, et al. Mineral metabolism in obese patients following vertical banded gastroplasty. Obes Surg. 2008;18:197–203.CrossRef
18.
Zurück zum Zitat Fried M, Hainer V, Basdevant A, et al. Bariatric scientific collaborative group expert panel. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.CrossRef Fried M, Hainer V, Basdevant A, et al. Bariatric scientific collaborative group expert panel. Interdisciplinary European guidelines for surgery for severe (morbid) obesity. Obes Surg. 2007;17:260–70.CrossRef
19.
Zurück zum Zitat Kalfarenztos F, Papadoulas S, Skroubis G, et al. Prospective evaluation of biliopancreatic diversion with Roux en Y gastric bypass in the super obese. J Gastrointest Surg. 2004;8:479–488.CrossRef Kalfarenztos F, Papadoulas S, Skroubis G, et al. Prospective evaluation of biliopancreatic diversion with Roux en Y gastric bypass in the super obese. J Gastrointest Surg. 2004;8:479–488.CrossRef
20.
Zurück zum Zitat Liel Y, Edwards J, Shary J, et al. The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women. J Clin Endocrinol Metab. 1988;66:1247–50.CrossRef Liel Y, Edwards J, Shary J, et al. The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women. J Clin Endocrinol Metab. 1988;66:1247–50.CrossRef
21.
Zurück zum Zitat Mazess RB, Barden HS, Drinka PJ, et al. Influence of age and body weight on spine and femur bone mineral density in U.S. white men. J Bone Miner Res. 1990;5:645–52.CrossRef Mazess RB, Barden HS, Drinka PJ, et al. Influence of age and body weight on spine and femur bone mineral density in U.S. white men. J Bone Miner Res. 1990;5:645–52.CrossRef
22.
Zurück zum Zitat Orozco P, Nolla JM. Associations between body morphology and bone mineral density in premenopausal women. Eur J Epidemiol. 1997;13:919–24.CrossRef Orozco P, Nolla JM. Associations between body morphology and bone mineral density in premenopausal women. Eur J Epidemiol. 1997;13:919–24.CrossRef
23.
Zurück zum Zitat Lean JM, Jagger CJ, Chambers TJ, et al. Increased insulin-like growth factor I mRNA expression in rat osteocytes in response to mechanical stimulation. Am J Physiol. 1995;268:E318–22.PubMed Lean JM, Jagger CJ, Chambers TJ, et al. Increased insulin-like growth factor I mRNA expression in rat osteocytes in response to mechanical stimulation. Am J Physiol. 1995;268:E318–22.PubMed
24.
Zurück zum Zitat Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–65.CrossRef Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–65.CrossRef
25.
Zurück zum Zitat Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg. 2004;14:9–12.CrossRef Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg. 2004;14:9–12.CrossRef
26.
Zurück zum Zitat Von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53:918–21.CrossRef Von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53:918–21.CrossRef
27.
Zurück zum Zitat Parikh SJ, Edelman M, Uwaifo GI, et al. The relationship between obesity and serum 1, 25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89:1196–9.CrossRef Parikh SJ, Edelman M, Uwaifo GI, et al. The relationship between obesity and serum 1, 25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89:1196–9.CrossRef
28.
Zurück zum Zitat Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: A review. Obes Surg. 2008;18:220–4.CrossRef Compher CW, Badellino KO, Boullata JI. Vitamin D and the bariatric surgical patient: A review. Obes Surg. 2008;18:220–4.CrossRef
29.
Zurück zum Zitat Snijder MB, Van Dam RM, Visser M, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population based study in older men and women. J Clin Endocrinol Metab. 2005;90:4119–23.CrossRef Snijder MB, Van Dam RM, Visser M, et al. Adiposity in relation to vitamin D status and parathyroid hormone levels: a population based study in older men and women. J Clin Endocrinol Metab. 2005;90:4119–23.CrossRef
30.
Zurück zum Zitat Arunabh S, Pollack S, Yeh J, et al. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab. 2003;88:157–61.CrossRef Arunabh S, Pollack S, Yeh J, et al. Body fat content and 25-hydroxyvitamin D levels in healthy women. J Clin Endocrinol Metab. 2003;88:157–61.CrossRef
31.
32.
Zurück zum Zitat DiGiorgi M, Daud A, Inabnet WB, et al. Markers of bone and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding. Obes Surg. 2008;18:1144–8.CrossRef DiGiorgi M, Daud A, Inabnet WB, et al. Markers of bone and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding. Obes Surg. 2008;18:1144–8.CrossRef
33.
Zurück zum Zitat Skroubis G, Anesidis S, Kehagias I, et al. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: Prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16:488–95.CrossRef Skroubis G, Anesidis S, Kehagias I, et al. Roux-en-Y gastric bypass versus a variant of biliopancreatic diversion in a non-superobese population: Prospective comparison of the efficacy and the incidence of metabolic deficiencies. Obes Surg. 2006;16:488–95.CrossRef
34.
Zurück zum Zitat Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.CrossRef Skroubis G, Sakellaropoulos G, Pouggouras K, et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg. 2002;12:551–8.CrossRef
35.
Zurück zum Zitat 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;9:106–10. 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;9:106–10.
Metadaten
Titel
Bone Mass Decreases in Morbidly Obese Women after Long Limb-Biliopancreatic Diversion and Marked Weight Loss Without Secondary Hyperparathyroidism. A Physiological Adaptation to Weight Loss?
verfasst von
Dimitrios D. A. Tsiftsis
Panagiotis Mylonas
Nancy Mead
Fotis Kalfarentzos
Theodore K. Alexandrides
Publikationsdatum
01.11.2009
Verlag
Springer New York
Erschienen in
Obesity Surgery / Ausgabe 11/2009
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-009-9938-z

Weitere Artikel der Ausgabe 11/2009

Obesity Surgery 11/2009 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.