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Obesity Surgery

, Volume 19, Issue 8, pp 1132–1138 | Cite as

Increase of Bone Resorption and the Parathyroid Hormone in Postmenopausal Women in the Long-term after Roux-en-Y Gastric Bypass

  • Juan P. ValderasEmail author
  • Soledad Velasco
  • Sandra Solari
  • Yessica Liberona
  • Paola Viviani
  • Alberto Maiz
  • Alex Escalona
  • Gilberto González
Research Clinical

Abstract

Background

The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone mineral density (BMD) 1 to 5 years after RYGB.

Methods

We designed a retrospective cohort study in 26 postmenopausal women (58.0 ± 3.9 years old) with RYGB 3.5 ± 1.1 years before (body mass index (BMI) 29.5 ± 3.8 kg/m2, presurgery 43.6 ± 5.5 kg/m2) and 26 nonoperated women (57.5 ± 4.7 years old, BMI 29.2 ± 4.1 kg/m2) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin.

Results

RYGB group, compared to nonoperated women, had higher CTx (0.71 ± 0.21 vs. 0.43 ± 0.15 ng/ml; P < 0.01) and PTH (68.3 ± 35 vs. 49.4 ± 16 pg/ml; P = 0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759 ± 457 vs. 705 ± 460 mg/day; 176 ± 160 vs. 111 ± 86 UI/day), ghrelin (763 ± 336 vs. 621 ± 274 pg/ml), ALP (101 ± 22 vs. 94 ± 25 UI/l), 25OHD (18.8  ± 7.6 vs. 17.4 ± 5.9 ng/ml), lumbar spine BMD (1.059 ± 0.32 vs. 1.071 ± 0.207 g/cm2), or femoral neck BMD (0.892 ± 0.109 vs. 0.934 ± 1.1 g/cm2).

Conclusions

RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB.

Keywords

Bariatric surgery Gastric bypass Hyperparathyroidism Bone Obesity Menopause 

Notes

Acknowledgements

This study was supported by funds from the Department of Nutrition, Diabetes, and Metabolism, School of Medicine, Pontificia Universidad Católica de Chile. We would like to thank Ms. Susan Smalley M. for her critical review in English of our manuscript and to Ms. Jacqueline Parada for the CTx measurements.

Disclosure statement

The authors have nothing to disclose.

References

  1. 1.
    Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg. 2004;14:1157–64.CrossRefGoogle Scholar
  2. 2.
    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.CrossRefGoogle Scholar
  3. 3.
    Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;375:753–61.CrossRefGoogle Scholar
  4. 4.
    Decker GA, Swain JM, Crowell MD, et al. Gastrointestinal and nutritional complications after bariatric surgery. Am J Gastroenterol. 2007;102:2571–80.CrossRefGoogle Scholar
  5. 5.
    Wucher H, Ciangura C, Poitou C, et al. Effects of weight loss on bone status after bariatric surgery: association between adipokines and bone markers. Obes Surg. 2008;18:58–65.CrossRefGoogle Scholar
  6. 6.
    Reid IR. Relationships among body mass, its components, and bone. Bone. 2002;31:547–55.CrossRefGoogle Scholar
  7. 7.
    Escalona A, Devaud N, Pérez G, et al. Antecolic versus retrocolic alimentary limb in laparoscopic Roux-en-Y gastric bypass: a comparative study. Surg Obes Relat Dis. 2007;3:423–7.CrossRefGoogle Scholar
  8. 8.
    Salamone LM, Dallal GE, Zantos D, et al. Contributions of vitamin D intake and seasonal exposure to plasma 25-hydroxivitamin D concentration in elderly women. Am J Clin Nutr. 1994;59:80–6.CrossRefGoogle Scholar
  9. 9.
    Castillo O, Rozowski J, Muñoz X, et al. Nutrient intake in Chilean vegetarians. Rev Chil Nutr. 1998;25:39–44.Google Scholar
  10. 10.
    González G, Alvarado JN, Rojas A, et al. High prevalence of vitamin D deficiency in Chilean healthy postmenopausal women with normal sun exposure: additional evidence for a worldwide concern. Menopause. 2007;14:455–61.CrossRefGoogle Scholar
  11. 11.
    Goode LR, Brolin RE, Chowdhury HA, et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12:40–7.CrossRefGoogle Scholar
  12. 12.
    US Department of Health and Human Services, US Department of Agriculture Dietary Guidelines for Americans. https://doi.org/www.health.gov/dietaryguidelines/dga2005/default.htm (2005). Accessed October 31, 2008.
  13. 13.
    Garnero P, Borel O, Delmas PD. Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clin Chem. 2001;47:694–702.PubMedGoogle Scholar
  14. 14.
    Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89:1061–5.CrossRefGoogle Scholar
  15. 15.
    Shapses S, Riedt C. Bone, body weight, and weight reduction: what are the concerns? J Nutr. 2006;136:1453–6.CrossRefGoogle Scholar
  16. 16.
    O’Brien PE, McPhail T, Chaston TB, et al. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16:1032–340.CrossRefGoogle Scholar
  17. 17.
    Riedt CS, Brolin RE, Sherrel RM, et al. True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity. 2006;14:1940–8.CrossRefGoogle Scholar
  18. 18.
    Goldner WS, Stoner JA, Thompson J, et al. Prevalence of vitamin D insufficiency and deficiency in morbidly obese patients: a comparison with non-obese controls. Obes Surg. 2008;18:145–50.CrossRefGoogle Scholar
  19. 19.
    Rueda S, Fernández-Fernández C, Romero F, et al. Vitamin D, PTH, and metabolic syndrome in severely obese subjects. Obes Surg. 2008;18:151–4.CrossRefGoogle Scholar
  20. 20.
    Carlin AM, Rao DS, Yager KM, et al. Treatment of vitamin D depletion after Roux-en-Y gastric bypass: a randomized prospective clinical trial. Surg Obes Relat Dis 2008; in press.Google Scholar
  21. 21.
    Johnson JM, Maher JW, DeMaria EJ, et al. The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg. 2006;243:701–4.CrossRefGoogle Scholar
  22. 22.
    Jin J, Robinson AV, Hallowell PT, et al. Increases in parathyroid hormone (PTH) after gastric bypass surgery appear to be of a secondary nature. Surgery. 2007;142:914–20.CrossRefGoogle Scholar
  23. 23.
    Fleischer J, Stein EM, Bessler M, et al. The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab. 2008;93:3735–40.CrossRefGoogle Scholar
  24. 24.
    Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15:1024–9.CrossRefGoogle Scholar
  25. 25.
    Lehto-Axtelius D, Stenstrom M, Johnell O. Osteopenia after gastrectomy, fundectomy or antrectomy: an experimental study in the rat. Regul Pept. 1998;78:41–50.CrossRefGoogle Scholar
  26. 26.
    van der Velde M, Delhanty P, van der Eerden B, et al. Ghrelin and bone. Vitam Horm. 2008;77:239–58.CrossRefGoogle Scholar
  27. 27.
    Misra M, Miller KK, Stewart V, et al. Ghrelin and bone metabolism in adolescent girls with anorexia nervosa and healthy adolescents. J Clin Endocrinol Metab. 2005;90:5082–7.CrossRefGoogle Scholar
  28. 28.
    Huda MS, Durham BH, Wong SP, et al. Lack of an acute effect of ghrelin on markers of bone turnover in healthy controls and post-gastrectomy subjects. Bone. 2007;41:406–13.CrossRefGoogle Scholar
  29. 29.
    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
  30. 30.
    De Laet C, Kanis JA, Odén A, et al. Body mass index as a predictor of fracture risk: a meta-analysis. Osteoporos Int. 2005;16:1330–8.CrossRefGoogle Scholar
  31. 31.
    Patel R, Blake GM, Rymer J, et al. Long-term precision of DXA scanning assessed over seven years in forty postmenopausal women. Osteoporos Int. 2000;11:68–75.CrossRefGoogle Scholar
  32. 32.
    Woitge HW, Seibel MJ, Ziegler R. Comparison of total and bone-specific alkaline phosphatase in patients with nonskeletal disorder or metabolic bone diseases. Clin Chem. 1996;42:1796–804.PubMedGoogle Scholar
  33. 33.
    Garnero P, Sornay-Rendu E, Duboeuf F, et al. Markers of bone turnover predict postmenopausal forearm bone loss over 4 years: the OFELY study. J Bone Miner Res. 1999;14:1614–21.CrossRefGoogle Scholar
  34. 34.
    Bischoff-Ferrari HA, Giovannucci E, Willett WC, et al. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr. 2006;84:18–28.CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • Juan P. Valderas
    • 1
    Email author
  • Soledad Velasco
    • 2
  • Sandra Solari
    • 3
  • Yessica Liberona
    • 1
  • Paola Viviani
    • 5
  • Alberto Maiz
    • 1
  • Alex Escalona
    • 4
  • Gilberto González
    • 2
  1. 1.Department of Nutrition, Diabetes, and Metabolism, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
  2. 2.Department of Endocrinology, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
  3. 3.Department of Clinical Laboratory, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
  4. 4.Department of Digestive Surgery, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile
  5. 5.Department of Public Health, Faculty of MedicinePontificia Universidad Católica de ChileSantiagoChile

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