Abstract
Background
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).
Methods
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.
Results
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 (R 2 = 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 (R 2 = 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).
Conclusions
Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.
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References
Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.
Balsa JA, Botella-Carretero JI, Peromingo R, et al. Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. J Endocrinol Invest. 2008;31:845–50.
Newbury L, Dolan K, Hatzifotis M, et al. Depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg. 2003;13:893–5.
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 Relat Metab Disord. 2003;27:110–6.
Guney E, Kisakol G, Ozgen G, et al. Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg. 2003;13:383–8.
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.
Risteli L, Risteli J. Biochemical markers of bone metabolism. Ann Med. 1993;25:385–93.
Gamero P, Delmas PD. New developments in biochemical markers for osteoporosis. Calcif Tissue Int. 1996;52:S2–9.
Taylor AK, Lueken SA, Libanati C, et al. Biochemical markers of bone turnover for the clinical assessment of bone metabolism. Rheum Dis Clin North Am. 1994;20:589–607.
De Leo V, Ditto A, la Marca A, et al. Bone mineral density and biochemical markers of bone turnover in peri- and postmenopausal women. Calcif Tissue Int. 2000;66:263–7.
Kanis JA, Melton LJ 3rd, Christiansen C, et al. The diagnosis of osteoporosis. J Bone Miner Res. 1994;9:1137–41.
Duda RJ Jr, O’Brien JF, Katzmann JA, et al. Concurrent assays of circulating bone Gla-protein and bone alkaline phosphatase: effects of sex, age, and metabolic bone disease. J Clin Endocrinol Metab. 1988;66:951–7.
Deftos LJ, Parthemore JG, Price PA. Changes in plasma bone GLA protein during treatment of bone disease. Calcif Tissue Int. 1982;34:121–4.
Brown JP, Delmas PD, Malaval L, et al. Serum bone Gla-protein: a specific marker for bone formation in postmenopausal osteoporosis. Lancet. 1984;1:1091–3.
Okabe R, Nakatsuka K, Inaba M, et al. Clinical evaluation of the Elecsys β-CrossLaps serum assay, a new assay for degradation products of type I collagen C-telopeptides. Clin Chem. 2001;47:1410–4.
Fledelius C, Johnsen AH, Cloos PA, et al. Characterization of urinary degradation products derived from type I collagen. Identification of a β-isomerized Asp-Gly sequence within the C-terminal telopeptide (α1) region. J Biol Chem. 1997;272:9755–63.
Okabe R, Inaba1 M, Nakatsuka K, et al. Significance of serum CrossLaps as a predictor of changes in bone mineral density during estrogen replacement therapy; comparison with serum carboxyterminal telopeptide of type I collagen and urinary deoxypyridinoline. J Bone Miner Metab. 2004;22:127–31.
Rosenquist C, Fledelius C, Christgau S, et al. Serum CrossLaps One Step ELISA. First application of monoclonal antibodies for measurement in serum of bone-related degradation products from C-terminal telopeptides of type I collagen. Clin Chem. 1998;44:2281–9.
Slater GH, Ren CJ, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.
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.
Moreiro J, Ruiz O, Perez G, et al. Parathyroid hormone and bone marker levels in patients with morbid obesity before and after biliopancreatic diversion. Obes Surg. 2007;17:348–54.
Chapin BL, LeMar HJJ, Knodel DH, et al. Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg. 1996;131:1048–52.
Nieves JW. Osteoporosis: the role of micronutrients. Am J Clin Nutr. 2005;81:1232S–9S.
Rosen C, Chesnut CH 3rd, Mallinak NJ. The predictive value of biochemical markers of bone turnover for bone mineral density in early postmenopausal women treated with hormone replacement or calcium supplementation. J Clin Endocrinol Metab. 1997;82:1904–10.
Dresner-Pollak R, Parker RA, Poku M, et al. Biochemical markers of bone turnover reflect femoral bone loss in elderly women. Calcif Tissue Int. 1996;59:328–33.
Reeve J, Pearson J, Mitchell A, et al. Evolution of spinal bone loss and biochemical markers of bone remodelling after menopause in normal women. Calcif Tissue Int. 1995;57:105–10.
Ross PD, Knowlton W. Rapid bone loss is associated with increased levels of biochemical markers. J Bone Miner Res. 1996;13:297–302.
Riggs BL, Melton LJ III, O’Fallon WM. Drug therapy for vertebral fractures in osteoporosis: evidence that decreases in bone turnover and increases in bone mass both determine antifracture efficacy. Bone. 1996;18:S197–201.
Marceau P, Biron S, Lebel S, et al. Does bone change after biliopancreatic diversion? J Gastrointest Surg. 2002;6:690–8.
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Balsa, J.A., Botella-Carretero, J.I., Peromingo, R. et al. Chronic Increase of Bone Turnover Markers After Biliopancreatic Diversion is Related to Secondary Hyperparathyroidism and Weight Loss. Relation with Bone Mineral Density. OBES SURG 20, 468–473 (2010). https://doi.org/10.1007/s11695-009-0028-z
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DOI: https://doi.org/10.1007/s11695-009-0028-z