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Calcium metabolism, vitamin D and bone mineral density after bariatric surgery

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Abstract

Summary

Lower bone mineral density, vitamin D deficiency, lower lean body mass, greater loss of excess weight, and increased bone turnover are complications found after bariatric surgery correlated in the literature with increased risk of fractures. The prevention and treatment of such complications should begin immediately after surgery.

Introduction

The aims of the study were to evaluate bone mass in patients undergoing bariatric surgery by the Wittgrove technique after 1 year of the procedure and correlate it with body composition, weight loss, 25OH vitamin D levels, and markers of bone metabolism.

Methods

The operated group (OG) participated in a clinical consultation; a blood sample taken and a body composition; and bone mineral density assessment by dual energy X-ray absorptiometry (DXA). The results were compared with a control group (CG).

Results

Fifty-six subjects in the OG and 27 in the CG were included. The bone mineral density (BMD), after the surgery, at the lumbar spine (LS) was lower in the OG than in the CG. There was a positive correlation between total body (TB) BMD with 25OHD, body mass index (BMI), and lean mass and an inverse correlation with percentage of excess weight loss (%EWL). Vitamin D deficiency was seen in 60.41 % (OG) and in 16.6 % (CG). PTH was higher in the OG, with secondary hyperparathyroidism in 41.7 %. In 26.5 % and 14.2 % of the OG, ALP and OC levels were above the reference values. In <50 years, elevated values of carboxy-terminal telopeptide (CTX) were found in 66.7 % of patients. A difference was observed in the variation of CTX between 12 and 18 months when compared to over 24 months.

Conclusions

Lower BMD was observed, correlated with lower lean body mass and greater loss of excess weight. Vitamin D deficiency with high prevalence of secondary hyperparathyroidism and high bone turnover was detected. The prevention of bone loss should be initiated in the first months after surgery, which is a period associated with severe muscle loss and increased bone turnover.

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References

  1. Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S (2013) Early outcomes of Roux-en-Y gastric bypass in a publically funded obesity program. ISRN Obes 2013:296597

    PubMed Central  PubMed  Google Scholar 

  2. Riedt CS, Brolin RE, Sherrell RM, Field MP, Shapses SA (2006) True fractional calcium absorption is decreased after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 14(11):1940–1948

    Article  CAS  Google Scholar 

  3. Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass, Roux-en-Y- 500 patients: technique and results, with 3–60 month follow-up. Obes Surg 10(3):233–239

    Article  CAS  PubMed  Google Scholar 

  4. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society (2011) Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 96(7):1911–1930

    Article  CAS  PubMed  Google Scholar 

  5. Schousboe JT, Shepherd JA, Bilezikian JP, Baim S (2013) Executive summary of the 2013 international society for clinical densitometry position development. Conference on bone densitometry. J Clin Densitom 16(4):455–466

    Article  PubMed  Google Scholar 

  6. Kelly TL, Wilson KE, Heymsfield SB (2009) Dual energy X-Ray absorptiometry body composition reference values from NHANES. PLoS One 4(9):e7038

    Article  PubMed Central  PubMed  Google Scholar 

  7. Obesity: preventing and managing the global epidemic (2000) Report of a WHO consultation. World Health Organ Tech Rep Ser 894:i-xii, 1–253

  8. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737

    Article  CAS  PubMed  Google Scholar 

  9. Fonseca VM, Sichieri R, Veiga (1998) Fatores associados a obesidade em adolescentes. Rev Saude Publica 32(6):541–549

    Article  Google Scholar 

  10. Bowen J, Noakes M, Clifton PM (2004) A high dairy protein, high-calcium diet minimizes bone turnover in overweight adults during weight loss. J Nutr 134(3):568–573

    CAS  PubMed  Google Scholar 

  11. Youssef Y, Richards WO, Sekhar N, Kaiser J, Spagnoli A, Abumrad N, Torquati A (2007) Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc 21(8):1393–1396

    Article  CAS  PubMed  Google Scholar 

  12. Clarke B (2008) Normal bone anatomy and physiology. Clin J Am Soc Nephrol 3(Suppl 3):S131–S139

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Abbasi AA, Amin M, Smiertka JK, Grunberger G, MacPherson B, Hares M, Lutrzykowski M, Najar A (2007) Abnormalities of vitamin D and calcium metabolism after surgical treatment of morbid obesity: a study of 136 patients. Endocr Pract 13(2):131–136

    Article  PubMed  Google Scholar 

  14. Carrasco F, Ruz M, Rojas P, Csendes A, Rebolledo A, Codoceo J, Inostroza J, Basfi-Fer K, Papapietro K, Rojas J, Pizarro F, Olivares M (2009) Changes in bone mineral density, body composition and adiponectin levels in morbidly obese patients after bariatric surgery. Obes Surg 19(1):41–46

    Article  PubMed  Google Scholar 

  15. Uebelhart B (2013) Effects of bariatric surgery on bone. Rev Med Suisse 9(390):1251–1255

    CAS  PubMed  Google Scholar 

  16. Brzozowska MM, Sainsbury A, Eisman JA, Baldock PA, Center JR (2013) Bariatric surgery, bone loss, obesity and possible mechanisms. Obes Rev 14(1):52–67

    Article  CAS  PubMed  Google Scholar 

  17. Viégas M, Vasconcelos RS, Neves AP, Diniz ET, Bandeira F (2010) Bariatric surgery and bone metabolism: a systematic review. Arq Bras Endocrinol Metabol 54(2):158–163

    Article  PubMed  Google Scholar 

  18. Nakamura KM, Haglind EG, Clowes JA, Achenbach SJ, Atkinson EJ, Melton LJ 3rd, Kennel KA (2014) Fracture risk following bariatric surgery: a population-based study. Osteoporos Int 25(1):151–158

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. García AMJ, López VFJ, Martín CC, Sánchez VP, Cunill JLP (2012) Micronutrientes en cirugía bariátrica. Nutr Hosp 27(2):349–361

    Google Scholar 

  20. Fish E, Beverstein G, Olson D, Reinhardt S, Garren M, Gould J (2010) Vitamin D status of morbidly obese bariatric surgery patients. J Surg Res 164(2):198–202

    Article  CAS  PubMed  Google Scholar 

  21. Gemmel K, Santry HP, Prachand VN, Alverdy JC (2009) Vitamin D deficiency in preoperative bariatric surgery patients. Surg Obes Relat Dis 5(1):54–59

    Article  PubMed  Google Scholar 

  22. Kremer R, Campbell PP, Reinhardt T, Gilsanz V (2009) Vitamin D status and its relationship to body fat, final height, and peak bone mass in young women. J Clin Endocrinol Metab 94(1):67–73

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ (2008) Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Part A: vitamins. Obes Surg 18(7):870–876

    Article  PubMed  Google Scholar 

  24. Jin J, Stellato TA, Hallowell PT, Schuster M, Graf K, Wilhelm S (2009) Utilization of preoperative patient factors to predict postoperative vitamin D deficiency for patients undergoing gastric bypass. J Gastrointest Surg 13(6):1052–1057

    Article  PubMed  Google Scholar 

  25. Beckman LM, Earthman CP, Thomas W, Compher CW, Muniz J, Horst RL, Ikramuddin S, Kellogg TA, Sibley SD (2013) Serum 25(OH) vitamin D concentration changes after Roux-en-Y gastric bypass surgery. Obesity (Silver Spring) 21(12):E599–E606

    Article  CAS  Google Scholar 

  26. da Rosa CL, Dames Olivieri Saubermann AP, Jacqueline J, Pereira SE, Saboya C, Ramalho A (2013) Routine supplementation does not warrant the nutritional status of vitamin d adequate after gastric bypass Roux-en-Y. Nutr Hosp 28(1):169–172

    PubMed  Google Scholar 

  27. Toh SY, Zarshenas N, Jorgensen J (2009) Prevalence of nutrient deficiencies in bariatric patients. Nutrition 25(11–12):1150–1156

    Article  CAS  PubMed  Google Scholar 

  28. Gehrer S, Kern B, Peters T, Christoffel-Courtin C, Peterli R (2010) Fewer nutrient deficiencies after laparoscopic sleeve gastrectomy (LSG) than after laparoscopic Roux-Y-gastric bypass (LRYGB)—a prospective study. Obes Surg 20(4):447–453

    Article  PubMed  Google Scholar 

  29. Duran de Campos C, Dalcanale L, Pajecki D, Garrido AB Jr, Halpern A (2008) Calcium intake and metabolic bone disease after eight years of Roux-en-Y gastric bypass. Obes Surg 18(4):386–390

    Article  PubMed  Google Scholar 

  30. Sánchez-Hernández J, Ybarra J, Gich I, De Leiva A, Rius X, Rodríguez-Espinosa J, Pérez A (2005) Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study. Obes Surg 15(10):1389–1395

    Article  PubMed  Google Scholar 

  31. Cabral MA, Borges CN, Maia JM, Aires CA, Bandeira F (2013) Prevalence of vitamin D deficiency during the summer and its relationship with sun exposure and skin phototype in elderly men living in the tropics. Clin Interv Aging 8:1347–1351

    PubMed Central  PubMed  Google Scholar 

  32. Slater GH, Ren CJ, Siegel N, Williams T, Barr D, Wolfe B, Dolan K, Fielding GA (2004) Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 8(1):48–55

    Article  PubMed  Google Scholar 

  33. Mahlay NF, Verka LG, Thomsen K, Merugu S, Salomone M (2009) Vitamin D status before Roux-en-Y and efficacy of prophylactic and therapeutic doses of vitamin D in patients after Roux-en-Y gastric bypass surgery. Obes Surg 19(5):590–594

    Article  PubMed  Google Scholar 

  34. Flores L, Osaba MJ, Andreu A, Moizé V, Rodríguez L, Vidal J (2010) Calcium and vitamin D supplementation after gastric bypass should be individualized to improve or avoid hyperparathyroidism. Obes Surg 20(6):738–743

    Article  PubMed  Google Scholar 

  35. Clare Grace PD, Vincent R, Aylwin SJ (2013) High prevalence of vitamin D insufficiency in a United Kingdom urban morbidly obese population: implications for testing and treatment. Surg Obes Relat Dis 10(2):355–360

    Article  PubMed  Google Scholar 

  36. Jamal-Allial A, Griffith JL, Tucker KL (2013) The longitudinal association of vitamin D serum concentrations & adiposity phenotype. J Steroid Biochem Mol Biol

  37. Hewitt S, Søvik TT, Aasheim ET, Kristinsson J, Jahnsen J, Birketvedt GS, Bøhmer T, Eriksen EF, Mala T (2013) Secondary hyperparathyroidism, vitamin D sufficiency, and serum calcium 5 years after gastric bypass and duodenal switch. Obes Surg 23(3):384–390

    Article  PubMed  Google Scholar 

  38. Vasconcelos RS, Viégas M, Marques TF, Diniz ET, Lucena CS, Câmara Neto JB, Bandeira F (2010) Factors associated with secondary hyperparathyroidism in premenopausal women undergoing Roux-en-Y gastric bypass for the treatment of obesity. Arq Bras Endocrinol Metabol 54(2):233–238

    Article  PubMed  Google Scholar 

  39. Signori C, Zalesin KC, Franklin B, Miller WL, McCullough PA (2010) Effect of gastric bypass on vitamin D and secondary hyperparathyroidism. Obes Surg 20(7):949–952

    Article  PubMed  Google Scholar 

  40. Ocón Bretón J, Pérez Naranjo S, Gimeno Laborda S, Benito Ruesca P, García Hernández R (2005) Effectiveness and complications of bariatric surgery in the treatment of morbid obesity. Nutr Hosp 20(6):409–414

    PubMed  Google Scholar 

  41. Diniz Mde F, Diniz MT, Sanches SR, Salgado PP, Valadão MM, Araújo FC, Martins DS, Rocha AL (2004) Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg 14(9):1222–1226

    Article  PubMed  Google Scholar 

  42. Pereira FA, de Castro JA, dos Santos JE, Foss MC, Paula FJ (2007) Impact of marked weight loss induced by bariatric surgery on bone mineral density and remodeling. Braz J Med Biol Res 40(4):509–517

    Article  CAS  PubMed  Google Scholar 

  43. Santos MT, Souza FI, Fonseca FL, Lazaretti-Castro M, Sarni RO (2012) Changes in bone metabolism markers in women after Roux-en-Y gastric bypass. Arq Bras Endocrinol Metabol 56(6):376–382

    Article  PubMed  Google Scholar 

  44. El-Kadre LJ, Rocha PR, de Almeida Tinoco AC, Tinoco RC (2004) Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes Surg 14(8):1062–1066

    Article  PubMed  Google Scholar 

  45. Moreiro J, Ruiz O, Perez G, Salinas R, Urgeles JR, Riesco M, García-Sanz M (2007) Parathyroid hormone and bone marker levels in patients with morbid obesity before and after biliopancreatic diversion. Obes Surg 17(3):348–354

    Article  CAS  PubMed  Google Scholar 

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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.

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Authors and Affiliations

  1. Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da Universidade Federal do Paraná (SEMPR-UFPR), Avenida Agostinho Leão Júnior, 285, 80030-110, Curitiba, PR, Brazil

    T. L. Costa, M. Paganotto, R. B. Radominski, C. M. Kulak & V. C. Borba

  2. Department of Internal Medicine, Universidade Federal do Paraná—UFPR, Curitiba, Brazil

    T. L. Costa, C. M. Kulak & V. C. Borba

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  1. T. L. Costa
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  2. M. Paganotto
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Costa, T.L., Paganotto, M., Radominski, R.B. et al. Calcium metabolism, vitamin D and bone mineral density after bariatric surgery. Osteoporos Int 26, 757–764 (2015). https://doi.org/10.1007/s00198-014-2962-4

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  • DOI: https://doi.org/10.1007/s00198-014-2962-4

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