Clinical Research

Obesity Surgery

, Volume 20, Issue 4, pp 468-473

Chronic Increase of Bone Turnover Markers After Biliopancreatic Diversion is Related to Secondary Hyperparathyroidism and Weight Loss. Relation with Bone Mineral Density

  • José Antonio BalsaAffiliated withDepartment of Endocrinology and Clinical Nutrition, Hospital Ramón y CajalUnit of Obesity Surgery, Hospital Ramón y Cajal Email author 
  • , José I. Botella-CarreteroAffiliated withDepartment of Endocrinology and Clinical Nutrition, Hospital Ramón y CajalUnit of Obesity Surgery, Hospital Ramón y Cajal
  • , Roberto PeromingoAffiliated withDepartment of Surgery, Hospital Ramón y CajalUnit of Obesity Surgery, Hospital Ramón y Cajal
  • , Carmen CaballeroAffiliated withDepartment of Nuclear Medicine, Hospital Ramón y Cajal
  • , Teresa Muñoz-MaloAffiliated withDepartment of Biochemistry, Hospital Ramón y Cajal
  • , Juan J. VillafruelaAffiliated withDepartment of Biochemistry, Hospital Ramón y Cajal
  • , Francisco ArrietaAffiliated withDepartment of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal
  • , Isabel ZamarrónAffiliated withDepartment of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal
  • , Clotilde VázquezAffiliated withDepartment of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal

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Abstract

Background

Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD).

Methods

Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD.

Results

BPD patients showed significantly higher PTH, osteocalcin, and β-CTx levels than controls. In the multivariate regression analysis, only PTH (β = 0.42; P = 0.0002), menopausal status (β = 0.31; P = 0.007) and the percentage of lost BMI (β = −0.24; P = 0.03) significantly predicted the osteocalcin level (R 2 = 0.33; F = 9.56; P < 0.0001). Similarly, only PTH (β = 0.39; P = 0.0005), menopausal status (β = 0.37; P = 0.001) and the percentage of lost BMI (β = −0.23; P = 0.04) significantly predicted the β-CTx level (R 2 = 0.33; F = 9.82; P < 0.0001). Osteocalcin and β-CTx levels correlated negatively with BMD at lumbar spine (r = −0.38, P = 0.002 and r = −0.30, P = 0.02, respectively).

Conclusions

Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.

Keywords

Bone turnover Secondary hyperparathyroidism Biliopancreatic diversion