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06.01.2019 | Original Contribution | Ausgabe 4/2019

Obesity Surgery 4/2019

The Impact of Roux-en-Y Gastric Bypass on Bone Remodeling Expressed by the P1NP/βCTX Ratio: a Single-Center Prospective Cohort Study

Obesity Surgery > Ausgabe 4/2019
Markus K. Muller, Daniel Gero, Daniela Reitnauer, Diana Vetter, Dilmurodjon Eshmuminov, Thorsten Hornemann, Marco Bueter
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11695-018-03640-3) contains supplementary material, which is available to authorized users.
Markus K. Muller, Daniel Gero, Thorsten Hornemann and Marco Bueter contributed equally to this work.
The Best Oral Presentation Prize was awarded to Daniel Gero for presenting this study at the 8th International Federation of Surgery of Obesity – European Chapter meeting in Athens, Greece on 19th May 2018.

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Bariatric surgery seems to decrease bone mineral density and increase the risk of fatigue fractures. P1NP (bone formation) and βCTX (bone resorption) were recently validated as reference bone turnover markers (BTM).


To assess changes in bone remodeling in severely obese patients undergoing Roux-en-Y gastric bypass (RYGB) by using a new composite biomarker, the P1NP/βCTX ratio.


We prospectively collected blood samples preoperatively, at 1 month and at 1 year from 114 consecutive RYGB patients from 12/2012 to 04/2014. Repeated measures ANOVA and multiple regression were used for data analysis. Cumulative incidence of fractures was assessed in 06/2018.


The P1NP/βCTX ratio decreased significantly (P < 0.001) from baseline to 1 month and 1 year (180 ± 6.6, 110 ± 4.1, and 132 ± 5.4). The 1-year P1NP/βCTX ratio did not correlate with BMI or ΔBMI, but inversely correlated with age (r = − 0.23, P = 0.014) and with hsCRP (r = − 0.26, P = 0.009), even after adjustment for age, sex, BMI, and lifestyle, and linearly correlated with albumin (r = 0.2, P = 0.037). At baseline, none of these correlations were detectable. Serum for all time-points was available from > 94% of the patients. At a median follow-up of 4.7 years, 8 patients (7.3%) had a bone fracture, all of them traumatic.


Following RYGB, bone remodeling increases, with a shift toward degradation. This effect seems to be weight-loss independent and shows a correlation with age, with the level of systemic inflammation, and with nutritional state. The risk of fractures should be assessed systematically in bariatric patients and measures of prevention should be improved accordingly.

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