Obesity Surgery

, Volume 18, Issue 9, pp 1144–1148 | Cite as

Markers of Bone and Calcium Metabolism Following Gastric Bypass and Laparoscopic Adjustable Gastric Banding

  • Mary DiGiorgi
  • Amna Daud
  • William B. Inabnet
  • Beth Schrope
  • Meredith Urban-Skuro
  • Nancy Restuccia
  • Marc Bessler
Research Article

Abstract

Background

Several studies have suggested that morbid obesity is associated with vitamin D deficiency and elevated parathyroid hormone (PTH). Studies have also suggested that there is an increase in vitamin D deficiency, bone resorption, and elevated PTH after gastric bypass surgery. Few studies have evaluated markers of bone and calcium metabolism after laparoscopic adjustable gastric banding or compared these results to those after gastric bypass.

Methods

Data on all patients undergoing primary gastric bypass (GBP; n = 979) and laparoscopic adjustable gastric banding (LAGB; n = 269) procedures at a tertiary-referral center from June 1996 through March 2005 were reviewed from a prospective database. Only patients with 25OH vitamin D levels available were included in this study (n = 534; GBP = 403, LAGB = 131). All patients were advised to take at least 1,200 mg calcium and 800–1,200 IU of vitamin D daily before and subsequent to their operation. Markers for bone metabolism [25OH Vitamin D, corrected serum calcium, alkaline phosphatase (AP), and PTH] were evaluated preoperatively and 3, 6, 12, and 24 months postoperatively. An analysis of variance and chi-square were performed to determine differences between the operative groups. Linear regression analysis was performed to evaluate the relationship between preoperative body mass index (BMI) and 25OH vitamin D and PTH levels and between percent excess weight loss and 25OH vitamin D and PTH after surgery.

Results

Sixty-four percent of all patients presented with vitamin D deficiency (<20 ng/ml) and 14% presented with elevated PTH preoperatively. Mean 25OH vitamin D levels and AP levels increased significantly after GBP surgery (vitamin D, 17 to 25 ng/ml 12 months post-op; AP, 80 to 90 IU/L 24 months post-op). Corrected calcium levels remained within normal limits and showed no change over time after both procedures. AP levels significantly increased from 76 IU/l preoperatively to 82 IU/l 6 months after LAGB surgery and then decreased to 59 IU/l 24 months after LAGB surgery. Linear regression analysis of preoperative vitamin D, PTH, and BMI values showed a significant positive relationship between initial BMI and PTH (r = 0.29) and a significant negative relationship between vitamin D and initial BMI (r = −0.19). A significant positive linear relationship between vitamin D and percent excess weight loss was evident 12 and 24 months after GBP surgery (r = 0.39 and 0.57, respectively). A negative relationship was evident between PTH and vitamin D 6 months after GBP surgery (r = −0.35) and 12 months after LAGB surgery (r = −0.61).

Conclusions

These findings suggest that morbid obesity is associated with vitamin D deficiency, and elevated PTH and with adequate supplementation, GBP, and particularly LAGB, patients can improve their bone metabolism abnormalities related to obesity. Furthermore, adequate supplementation for GBP patients may attenuate the increased risk for bone loss associated with malabsorption from the bypass.

Keywords

Bone metabolism Obesity surgery Morbid obesity Vitamin D Parathyroid hormone Vitamin D deficiency Hyperparathyroidism Gastric bypass Laparoscopic adjustable gastric banding 

References

  1. 1.
    Hey H, Stokholm KH, Lund B, Lund B, Sorensen OH. Vitamin D deficiency in obese patients and changes in circulating vitamin D metabolites following jejunoileal bypass. Int J Obes. 1982;6(5):473–9.PubMedGoogle Scholar
  2. 2.
    Buffington C, Walker B, Cowan GSM, Scruggs D. Vitamin D deficiency in the morbidly obese. Obes Surg. 1993;3:421–4.PubMedCrossRefGoogle Scholar
  3. 3.
    Hamoui N, Anthone G, Crookes PF. Calcium metabolism in the morbidly obese. Obes Surg. 2004;14:9–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Sanchez-Hernandez J, Ybarra J, Gich I, et al. Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study. Obes Surg. 2005;15:1389–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Hamoui N, Kim K, Anthone G, et al. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg. 2003;138:891–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Madan AK, Orth WS, Tichansky DS, Ternovits CA. Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg. 2006;16:603–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Johnson JM, Maher JW, Demaria EJ, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006;243:701–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson JM, Maher JW, Samuel I, Heitshusen D, Doherty C, Downs RW. Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J Gastrointest Surg. 2005;9:1106–10.PubMedCrossRefGoogle Scholar
  9. 9.
    El-Kadre LJ, Rocha PR, de Almeida Tinoco AC, Tinoco RC. Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2004;14:1062–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Ybarra J, Sanchez-Hernandez J, Gich I, De Leiva A, Rius X, Rodriguez-Espinosa J, et al. Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg. 2005;15:330–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Diniz Mde F, Diniz MT, Sanches SR, et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg. 2004;14:1222–6.PubMedCrossRefGoogle Scholar
  12. 12.
    Goode LR, Brolin RE, Chowdhury HA, Shapses SA. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Coates PS, Fernstrom JD, Fernstrom MH, Schauer PR, Greenspan SL. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89(3):1061–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Ott MT, Fanti P, Malluche HH, Ryo UY, Whaley FS, Strodel WE, et al. Biochemical evidence of metabolic bone disease in women following Roux-Y gastric bypass for morbid obesity. Obes Surg. 1992;2:341–8.PubMedCrossRefGoogle Scholar
  15. 15.
    De Prisco C, Levine SN. Metabolic bone disease after gastric bypass surgery for obesity. Am J Med Sci. 2005;329:57–61.PubMedCrossRefGoogle Scholar
  16. 16.
    Von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism. 2004;53:918–21.CrossRefGoogle Scholar
  17. 17.
    Pugnale N, Giusti V, Suter M, et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes. 2003;27:110–6.CrossRefGoogle Scholar
  18. 18.
    Giusti V, Suter M, Heraief E, et al. Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg. 2004;14:239–45.PubMedCrossRefGoogle Scholar
  19. 19.
    Giusti V, Gasteyger C, Suter M, et al. Gastric banding induces negative bone remodeling in the absence of secondary hyperparathyroidism: potential role of serum C telopeptides for follow up. Int J Obes. 2005;29:1429–35.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2007

Authors and Affiliations

  • Mary DiGiorgi
    • 1
    • 2
  • Amna Daud
    • 1
  • William B. Inabnet
    • 1
  • Beth Schrope
    • 1
  • Meredith Urban-Skuro
    • 1
  • Nancy Restuccia
    • 1
  • Marc Bessler
    • 1
  1. 1.Center for Obesity SurgeryColumbia University Medical CenterNew YorkUSA
  2. 2.New YorkUSA

Personalised recommendations