Obesity Surgery

, Volume 20, Issue 4, pp 468–473 | Cite as

Chronic Increase of Bone Turnover Markers After Biliopancreatic Diversion is Related to Secondary Hyperparathyroidism and Weight Loss. Relation with Bone Mineral Density

  • José Antonio Balsa
  • José I. Botella-Carretero
  • Roberto Peromingo
  • Carmen Caballero
  • Teresa Muñoz-Malo
  • Juan J. Villafruela
  • Francisco Arrieta
  • Isabel Zamarrón
  • Clotilde Vázquez
Clinical Research



Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD).


Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD.


BPD patients showed significantly higher PTH, osteocalcin, and β-CTx levels than controls. In the multivariate regression analysis, only PTH (β = 0.42; P = 0.0002), menopausal status (β = 0.31; P = 0.007) and the percentage of lost BMI (β = −0.24; P = 0.03) significantly predicted the osteocalcin level (R2 = 0.33; F = 9.56; P < 0.0001). Similarly, only PTH (β = 0.39; P = 0.0005), menopausal status (β = 0.37; P = 0.001) and the percentage of lost BMI (β = −0.23; P = 0.04) significantly predicted the β-CTx level (R2 = 0.33; F = 9.82; P < 0.0001). Osteocalcin and β-CTx levels correlated negatively with BMD at lumbar spine (r = −0.38, P = 0.002 and r = −0.30, P = 0.02, respectively).


Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.


Bone turnover Secondary hyperparathyroidism Biliopancreatic diversion 


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Copyright information

© Springer Science + Business Media, LLC 2009

Authors and Affiliations

  • José Antonio Balsa
    • 1
    • 5
  • José I. Botella-Carretero
    • 1
    • 5
  • Roberto Peromingo
    • 2
    • 5
  • Carmen Caballero
    • 3
  • Teresa Muñoz-Malo
    • 4
  • Juan J. Villafruela
    • 4
  • Francisco Arrieta
    • 1
  • Isabel Zamarrón
    • 1
  • Clotilde Vázquez
    • 1
  1. 1.Department of Endocrinology and Clinical NutritionHospital Ramón y CajalMadridSpain
  2. 2.Department of SurgeryHospital Ramón y CajalMadridSpain
  3. 3.Department of Nuclear MedicineHospital Ramón y CajalMadridSpain
  4. 4.Department of BiochemistryHospital Ramón y CajalMadridSpain
  5. 5.Unit of Obesity SurgeryHospital Ramón y CajalMadridSpain

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