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Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

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Abstract

Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and bone architecture assessed using dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), 6 and 12 months after RYGB, and correlate them to changes in selected biochemical markers. A prospective cohort study included 25 morbidly obese patients (10 males, 15 females). Patients were examined with DXA of the hip and spine, HR-pQCT of radius and tibia, and blood sampling before and 6 and 12 months after RYGB. Patients lost in average 33.5 ± 12.1 kg (25.8 ± 8.5 %) in 12 months. In tibia, we found significant loss of total, cortical and trabecular volumetric BMD after 12 months (all p < 0.001). Microarchitectural changes involved lower trabecular number, increased trabecular separation, and network inhomogeneity along with thinning of the cortex. Estimated bone failure load was decreased after 12 months (p = 0.005). We found only minor changes in radius. Results demonstrate significant alterations of bone microarchitecture suggesting an accelerated endosteal resorption along with disintegration of the trabecular structure which resulted in a loss of estimated bone strength in tibia. Such changes may underlie the recently reported increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.

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Acknowledgments

Thanks to Steffanie Anthony Christensen and the rest of the staff at the Osteoporosis clinic, Odense University Hospital, for patient management.

Funding

The study was supported by grants from the region of Southern Denmark.

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    Authors and Affiliations

    1. Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark

      Katrine Diemer Frederiksen, Stine Hanson, Stinus Hansen, Kim Brixen & René Klinkby Støving

    2. Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark

      Stinus Hansen & Niklas Rye Jørgensen

    3. Department of Endocrinology, Hospital of Southwest Denmark, Finsensgade 35, 6700, Esbjerg, Denmark

      Jeppe Gram

    4. Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Ndr. Ringvej 57, 2600, Glostrup, Denmark

      Niklas Rye Jørgensen

    5. Center for Eating Disorders, Odense University Hospital, Kløvervænget 6, 8. sal, 5000, Odense C, Denmark

      René Klinkby Støving

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    1. Katrine Diemer Frederiksen
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    Correspondence to Katrine Diemer Frederiksen.

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    Conflict of interest

    KD. Frederiksen, S. Hanson S. Hansen, J. Gram and N.R. Jørgensen had no conflicts of interest related to the current study. K. Brixen has received consultant fees and grants from MSD, are investigator for MSD, Amgen, Novartis and NPS and part in speakers bureau for Amgen and GlaxoSmithKline. R.K. Stoving has received consultant and lecture fees from Novo Nordisk.

    Human and Animal Rights and Informed Consent

    All participants provided written informed consent before inclusion, and the study was approved by The Regional Scientific Ethical Committee for Southern Denmark (File No. 2011-0050).

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    Katrine Diemer Frederiksen and Stine Hanson have contributed equally to this work.

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    Frederiksen, K.D., Hanson, S., Hansen, S. et al. Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT. Calcif Tissue Int 98, 253–262 (2016). https://doi.org/10.1007/s00223-015-0091-5

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    • DOI: https://doi.org/10.1007/s00223-015-0091-5

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