Clinical Reviews in Bone and Mineral Metabolism

, Volume 12, Issue 4, pp 207–227

Bariatric Surgery and Bone Loss: Do We Need to Be Concerned?

  • Malgorzata Monika Brzozowska
  • Amanda Sainsbury
  • John A. Eisman
  • Paul A. Baldock
  • Jacqueline R. Center
Original Paper

DOI: 10.1007/s12018-014-9162-9

Cite this article as:
Brzozowska, M.M., Sainsbury, A., Eisman, J.A. et al. Clinic Rev Bone Miner Metab (2014) 12: 207. doi:10.1007/s12018-014-9162-9

Abstract

Despite significant improvement in weight and comorbid conditions, there is growing evidence that bariatric surgery may exert a negative effect on the skeleton. This review has focused on the impact of bariatric surgery on bone health, with the concern that bariatric surgery may increase skeletal fragility and fracture risk by accelerating bone loss. We have highlighted studies evaluating changes in bone metabolism after three commonly performed bariatric procedures including laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass surgery and increasingly popular sleeve gastrectomy. This review has also discussed some of the technical issues faced in measuring bone in obese populations and during dynamic weight loss. There is limited evidence regarding potential mechanisms for the reported observations of increased bone turnover and/or bone loss after bariatric surgery. We have reviewed the evidence surrounding potential factors affecting bone health in bariatric patients such as rapid weight loss per se, nutritional deficiencies, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. Future prospective long-term cohort studies are needed to define how to quantify bone loss in individuals with obesity, particularly following massive weight loss, and for how long the bone changes continue. These studies will help clarify any negative clinical consequences of these changes, including future fracture risk in this unique group of patients.

Keywords

Bariatric surgery Bone loss Gut hormones Adiponectin Peripheral quantitative computed tomography Skeletal health 

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Malgorzata Monika Brzozowska
    • 1
  • Amanda Sainsbury
    • 2
    • 3
  • John A. Eisman
    • 1
    • 4
    • 5
    • 6
  • Paul A. Baldock
    • 1
    • 5
    • 7
  • Jacqueline R. Center
    • 1
    • 4
    • 5
  1. 1.Garvan Institute of Medical ResearchDarlinghurstAustralia
  2. 2.The Boden Institute of Obesity, Nutrition, Exercise & Eating DisordersThe University of SydneySydneyAustralia
  3. 3.School of Medical SciencesUniversity of New South WalesKensingtonAustralia
  4. 4.St Vincent’s Hospital Medical SchoolDarlinghurstAustralia
  5. 5.School of MedicineUniversity of New South WalesKensingtonAustralia
  6. 6.School of MedicineUniversity of Notre DameSydneyAustralia
  7. 7.Clinical SchoolSt Vincent’s HospitalDarlinghurstAustralia

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