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Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy

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Abstract

Purpose

Bariatric surgery may lead to metabolic bone disease.

Materials and Methods

In this cross-sectional study, we compared the prevalence of secondary hyperparathyroidism (SHPT), impact on bone mass and turnover markers, and serum leptin after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in 117 patients (91% female, 51% RYGB, age 41.8 ± 6.7 years, time of surgery 4.3 ± 3.4 years) at different times (1–2 years, > 2 and < 5 years and ≥ 5 years). Body composition, bone mineral density (BMD), by dual-energy X-ray absorptiometry, and bone parameters (PTH, serum calcium, 25OHD, alkaline phosphatase (AP), C-telopeptide (CTX)) were analyzed.

Results

Prevalence of SHPT (PTH ≥ 65 pg/ml) was 26%, RYGB > SG (18.4% vs. 7.8%, p = 0.039), despite similar 25OHD and calcium levels. Mean PTH, CTX, and AP were higher in RYGB vs. SG (61.3 ± 29.5 vs 49.5 ± 32.3 pg/ml, p = 0.001; 0.596 ± 0.24 vs. 0.463 ± 0.23 ng/ml; 123.9 ± 60.8 vs. 100.7 ± 62.0 U/l). There were 13.5% decreases in femoral neck BMD in all patients, over the study period. In the last group, the RYGB group showed greater bone loss in total body BMD (1.016 vs. 1.151 g/cm2, − 8.1%, p = 0.003) and total femur BMD (1.164 vs. 1.267 g/cm2, − 11.7%, p = 0.007). Mean leptin was lower in the RYGB vs. SG group, with no correlation with BMD in any site.

Conclusion

Our data suggest a more deleterious role of RYGB on bone remodeling up to 5 years postoperatively in comparison with SG.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brasil (CAPES) [Finance Code 001].

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Authors and Affiliations

  1. Department of Endocrinology, Federal University of Paraiba, Governador Antônio da Silva Mariz, 601, Portal Do Sol, João Pessoa, PB, CEP: 58046-518, Brazil

    Narriane Chaves Pereira de Holanda, Silvane Katarine Medeiros de Lima, Joao Modesto Filho & Caio Chaves de Holanda Limeira

  2. Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil

    Narriane Chaves Pereira de Holanda, Vanessa Mayana Alves Baad, Taisy Cinthia Ferro Cavalcante & Francisco Bandeira

  3. Division of Endocrinology and Diabetes, Agamenon Magalhães Hospital, University of Pernambuco Medical School, Recife, Brazil

    Louise Rayra Bezerra & Francisco Bandeira

  4. Instituto de Medicina Integral de Pernambuco – IMIP, Recife, Brazil

    Ana Carla Peres Montenegro

Authors
  1. Narriane Chaves Pereira de Holanda
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  2. Vanessa Mayana Alves Baad
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  3. Louise Rayra Bezerra
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  4. Silvane Katarine Medeiros de Lima
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  6. Caio Chaves de Holanda Limeira
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  8. Ana Carla Peres Montenegro
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  9. Francisco Bandeira
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Corresponding author

Correspondence to Narriane Chaves Pereira de Holanda.

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Ethics Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Key Points

1. There is a high prevalence of SHPT after bariatric surgery, especially after RYGB.

2. Bariatric surgery may lead to bone loss and increased bone turnover markers.

3. After 5 years of bariatric surgery, total BMD and total femur BMD have declined more significantly in RYGB patients compared with SG.

4. There was no correlation between serum leptin and bone loss in any site after bariatric surgery.

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de Holanda, N.C.P., Baad, V.M.A., Bezerra, L.R. et al. Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy. OBES SURG 31, 5367–5375 (2021). https://doi.org/10.1007/s11695-021-05739-6

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  • DOI: https://doi.org/10.1007/s11695-021-05739-6

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