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Changes in Bone Mineral Density, Body Composition and Adiponectin Levels in Morbidly Obese Patients after Bariatric Surgery



Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted.


Forty-two women (BMI 45.0 ± 4.3 kg/m2; 37.7 ± 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA.


Twelve months after, GBP weight was decreased by 34.4 ± 6.5% and excess weight loss was 68.2 ± 12.8%. Significant reduction (p < 0.001) in total BMD (−3.0 ± 2.1%), spine BMD (−7.4 ± 6.8%) and hip BMD (−10.5 ± 5.6%) were observed. Adiponectin concentration increased from 11.4 ± 0.7 mg/L before surgery to 15.7 ± 0.7 and 19.8 ± 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r 2 = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36).


GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.

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  1. 1.

    Haslam DW, James WPT. Obesity. Lancet 2005;366:1197–209.

    Article  Google Scholar 

  2. 2.

    Ministerio de Salud. Encuesta Nacional de Salud, 2003. /epi/html/ invest/ ENS/ENS_mayo2004.pdf. Minsal, Chile.

  3. 3.

    Bray GA. Overweight is risking fate: definition, classification, prevalence, and risks. Ann N Y Acad Sci. 1987;499:14–28.

    CAS  Article  Google Scholar 

  4. 4.

    WHO. Obesity. Preventing and management the global epidemic Report of a WHO Consultation on Obesity. Geneva: WHO; 1997.

  5. 5.

    Rosmond R, Lapidus L, Marin P, et al. Mental distress, obesity and body fat distribution in middle-aged men. Obes Res. 1996;4:245–52.

    CAS  Article  Google Scholar 

  6. 6.

    Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA 2003;289:187–93.

    Article  Google Scholar 

  7. 7.

    Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724–37.

    CAS  Article  Google Scholar 

  8. 8.

    Maggard MA, Shugarman LR, Suttorp M, et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.

    Article  Google Scholar 

  9. 9.

    Crookes PF. Surgical treatment of morbid obesity. Annu Rev Med. 2006;57:243–64.

    CAS  Article  Google Scholar 

  10. 10.

    Shah M, Simha V, Garg A. Long-term impact of bariatric surgery on body weight, comorbidities, and nutritional status. J Clin Endocrinol Metab. 2006;91:4223–31.

    CAS  Article  Google Scholar 

  11. 11.

    DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356:2176–83.

    CAS  Article  Google Scholar 

  12. 12.

    Bloomberg R, Fleishman A, Nalle J, et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg. 2005;15:145–54.

    Article  Google Scholar 

  13. 13.

    Ott MT, Fanti P, Malluche HH, et al. Biochemical evidence of metabolic bone disease in women following roux-Y gastric bypass for morbid obesity. Obes Surg. 1992;2:341–8.

    CAS  Article  Google Scholar 

  14. 14.

    Goldner WS, O’Dorisio TM, Dillon JS, et al. Severe metabolic bone disease as a long-term complication of obesity surgery. Obes Surg. 2002;12:685–92.

    Article  Google Scholar 

  15. 15.

    Shaker JL, Norton AJ, Woods MF, et al. Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity. Osteoporos Int. 1991;1:177–81.

    CAS  Article  Google Scholar 

  16. 16.

    Ricci TA, Heymsfield SB, Pierson RN, et al. Moderate energy restriction increases bone resorption in obese postmenopausal women. Am J Clin Nutr. 2001;73:347–52.

    CAS  Article  Google Scholar 

  17. 17.

    Edelstein SL, Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol. 1993;138:160–9.

    CAS  Article  Google Scholar 

  18. 18.

    Baumgartner RN, Ross RR, Waters DL, et al. Serum leptin in elderly people: associations with sex hormones, insulin, and adipose tissue volumes. Obes Res. 1999;7:141–9.

    CAS  Article  Google Scholar 

  19. 19.

    Thomas T, Burguera B. Is leptin the link between fat and bone mass. J Bone Miner Res. 2002;17:1563–9.

    CAS  Article  Google Scholar 

  20. 20.

    Maccarinelli G, Sibilia V, Torsello A, et al. Ghrelin regulates proliferation and differentiation of osteoblastic cells. J Endocrinol. 2005;184:249–56.

    CAS  Article  Google Scholar 

  21. 21.

    Lenchik L, Register TC, Hsu F-C, et al. Adiponectin as a novel determinant of bone mineral density and visceral fat. Bone 2003;33:646–51.

    CAS  Article  Google Scholar 

  22. 22.

    Csendes A, Burdiles P, Papapietro K, et al. Results of gastric bypass plus resection of the distal excluded gastric segment in patients with morbid obesity. J Gastrointest Surg. 2005;9:121–31.

    Article  Google Scholar 

  23. 23.

    Lohman TG. Anthropometry and body composition. In: Lohman TG, Roche AF, Martorell R, editors. Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics; 1988. p. 125–9.

    Google Scholar 

  24. 24.

    Jebb SA. Measurement of soft tissue composition by dual X-ray absorptiometry. Br J Nutr. 1997;77:151–63.

    CAS  Article  Google Scholar 

  25. 25.

    Clasey JL, Bouchard C, Teates CD, et al. The use of anthropometric and dual-energy X-ray absorptiometry (DXA) measures to estimate total abdominal and abdominal visceral fat in men and women. Obes Res. 1999;7:256–64.

    CAS  Article  Google Scholar 

  26. 26.

    Snijder MB, Visser M, Dekker JM, et al. The prediction of visceral fat by dual-energy X-ray absorptiometry in the elderly: a comparison with computed tomography and anthropometry. Int J Obes. 2002;26:984–93.

    CAS  Article  Google Scholar 

  27. 27.

    Snedecor GW, Cochran WG. Statistical methods, 8th edition. Ames, Iowa: The Iowa State University Press; 1989.

    Google Scholar 

  28. 28.

    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.

    Article  Google Scholar 

  29. 29.

    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.

    CAS  Article  Google Scholar 

  30. 30.

    Johnson JM, Maher JW, Samuel I, et al. Effects of gastric bypass procedures on bone mineral density, calcium, parathyroid hormone, and vitamin D. J Gastrointest Surg. 2005;9:1106–10.

    Article  Google Scholar 

  31. 31.

    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.

    Article  Google Scholar 

  32. 32.

    El-Kadre LJ, Savassi PR, de Almeida AC, et al. 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.

    Article  Google Scholar 

  33. 33.

    Silverberg SJ, Shane E, de la Cruz L, et al. Skeletal disease in primary hyperparathyroidism. J Bone Miner Res. 1989;4:283–91.

    CAS  Article  Google Scholar 

  34. 34.

    Dempster DW, Parisien M, Silverberg SJ, et al. On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism. J Clin Endocrinol Metab. 1999;84:1562–6.

    CAS  PubMed  Google Scholar 

  35. 35.

    Luo XH, Guo LJ, Xie H, et al. Adiponectin stimulates RANKL and inhibits OPG expression in human osteoblasts through the MAPK signaling pathway. J Bone Miner Res. 2006;21:1648–56.

    CAS  Article  Google Scholar 

  36. 36.

    Berner HS, Lyngstadaas SP, Spahr A, et al. Adiponectin and its receptors are expressed in bone-forming cells. Bone 2004;35:842–9.

    CAS  Article  Google Scholar 

  37. 37.

    Andersen RE, Wadden TA, Herzog RJ. Changes in bone mineral content in obese dieting women. Metabolism 1997;46:857–61.

    CAS  Article  Google Scholar 

  38. 38.

    Barrera G, Bunout D, Gattas V, et al. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition 2004;20:769–71.

    Article  Google Scholar 

  39. 39.

    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.

    Article  Google Scholar 

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Correspondence to Fernando Carrasco.

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Carrasco, F., Ruz, M., Rojas, P. et al. Changes in Bone Mineral Density, Body Composition and Adiponectin Levels in Morbidly Obese Patients after Bariatric Surgery. OBES SURG 19, 41–46 (2009).

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  • Bone mineral density
  • Gastric bypass
  • Adiponectin
  • Body composition