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Effects of Biliopancreatic Diversion on Bone Turnover Markers and Association with Hormonal Factors in Patients with Severe Obesity

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Abstract

Background

This study evaluated early and medium-term changes in bone turnover markers, and their associations with weight loss, total bone mineral density (BMD), and hormonal changes after biliopancreatic diversion (BPD).

Methods

Ancillary study from a one-year prospective cohort of 16 individuals assessed before, 3 days, 3 and 12 months after BPD. Bone turnover markers (C-terminal telopeptide (CTX), intact osteocalcin (OC), sclerostin, and osteoprotegerin (OPG)) and several hormones were measured at each visit. Total BMD by DXA was assessed at baseline, 3 and 12 months after BPD. Three participants were lost to follow-up.

Results

CTX increased significantly at 3 days (+ 66%), 3 months (+ 219%), and 12 months (+ 295%). OC decreased at 3 days (− 19%) then increased at 3 months (+ 69%) and 12 months (+ 164%). Change in sclerostin was only significant between 3 days and 3 months (+ 13%), while change in OPG was significant between baseline and 3 days (+ 48%) and baseline and 12 months (+ 45%). CTX increase correlated negatively with weight loss at 3 (r = − 0.63, p = 0.009) and 12 months (r = − 0.58, p = 0.039), and total BMD decrease (r = − 0.67, p = 0.033) at 12 months. Change in insulin and adiponectin correlated with changes in bone turnover markers independently of weight loss.

Conclusion

BPD causes an earlier and greater increase in bone resorption over bone formation markers and a decrease in total BMD. Sclerostin did not increase as expected following extensive weight loss. Changes in insulin and adiponectin seem to play a role in the activation of bone remodeling after BPD.

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Funding

The Canadian Institutes of Health Research (MOP 97947), Diabetes Canada and CHU de Québec Foundation provided funding for this research.

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Authors and Affiliations

  1. Endocrinology and Nephrology Unit, CHU de Québec Research Centre, 2705, Boulevard Laurier, Québec City, QC, G1V 4G2, Canada

    Anne-Frédérique Turcotte, Roth-Visal Ung, Fabrice Mac-Way, Laetitia Michou, André Tchernof & Claudia Gagnon

  2. CHU de Sherbrooke Research Centre, Sherbrooke, Canada

    Thomas Grenier-Larouche, Anne-Marie Carreau & André C. Carpentier

  3. Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada

    Thomas Grenier-Larouche, Anne-Marie Carreau & André C. Carpentier

  4. Clinical and Evaluative Research Platform, CHU de Québec-Université Laval Research Centre, Québec City, QC, Canada

    David Simonyan

  5. Department of Medicine, Université Laval, Québec City, Canada

    Fabrice Mac-Way, Laetitia Michou, André Tchernof & Claudia Gagnon

  6. Québec Heart and Lung Institute Research Centre, Québec City, Canada

    André Tchernof, Laurent Biertho, Stefane Lebel, Simon Marceau & Claudia Gagnon

  7. Institute of Nutrition and Functional Foods, Université Laval, Quebec City, QC, Canada

    André Tchernof & Claudia Gagnon

  8. Department of Surgery, Université Laval, Québec City, Canada

    Laurent Biertho, Stefane Lebel & Simon Marceau

Authors
  1. Anne-Frédérique Turcotte
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  2. Thomas Grenier-Larouche
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  3. Roth-Visal Ung
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  9. André Tchernof
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  13. Claudia Gagnon
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Corresponding author

Correspondence to Claudia Gagnon.

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Conflict of Interest

AMC is the recipient of Fonds de recherche du Québec-Santé (FRQ-S) and Diabetes Canada scholarships. ACC is the recipient of the GSK Chair in Diabetes of Université de Sherbrooke. LM reports non-financial support from Roche Diagnostics Canada, personal fees from Amgen, personal fees from Eli Lilly, personal fees from Abbvie, personal fees from Bristol-Myers Squibb, personal fees from Novartis, outside the submitted work. AT and LB receive funding from Johnson Johnson Medical Companies and Medtronic for research studies on bariatric surgery. CG is a clinical research scholar of the FRQ-S and the recipient of a Diabetes Canada New Investigator Award. She received research funding from Technologies Khlôros, and speaker honoraria from Amgen, Eli Lilly, and Janssen. All other authors report no conflicts of interest.

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Turcotte, AF., Grenier-Larouche, T., Ung, RV. et al. Effects of Biliopancreatic Diversion on Bone Turnover Markers and Association with Hormonal Factors in Patients with Severe Obesity. OBES SURG 29, 990–998 (2019). https://doi.org/10.1007/s11695-018-3617-x

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