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Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study

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Abstract

Purpose

Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).

Methods

A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery.

Results

123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery.

Conclusion

We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Authors and Affiliations

  1. Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy

    C. Greco, S. Coluccia, M. Teglio, B. Madeo, M. Simoni, V. Rochira & D. Santi

  2. Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy

    C. Greco, S. Coluccia, M. Bondi, B. Madeo, M. Simoni, V. Rochira & D. Santi

  3. Division of Internal Medicine and Metabolism, Department of Internal Medicine, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy

    F. Passerini

  4. Unit of Internal and Metabolic Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    F. Passerini

  5. Division of General, Emergency Surgery and New Technologies, Ospedale Civile di Baggiovara, Modena, Italy

    F. Mecheri, V. Trapani & A. Volpe

  6. Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria of Modena, Modena, Italy

    P. Toschi

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  1. C. Greco
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  2. F. Passerini
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Contributions

All the authors included in this article made substantial contributions to the data included, as well as assisted with critical revisions of the writing, and approved the final version for submission for publication.

Corresponding author

Correspondence to V. Rochira.

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Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. The study approval was granted by the Ethics Committee of Modena (Prot. Azienda Ospedaliero-Universitaria 0022400/21, approved on July 21, 2021).

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According to the Ethics Committee recommendations and considering the retrospective study design, informed consent was waived since data were collected anonymously.

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Greco, C., Passerini, F., Coluccia, S. et al. Long-term trajectories of bone metabolism parameters and bone mineral density (BMD) in obese patients treated with metabolic surgery: a real-world, retrospective study. J Endocrinol Invest 46, 2133–2146 (2023). https://doi.org/10.1007/s40618-023-02066-8

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