Abstract
Background
Metabolic bone disease is a potential complication of bariatric surgery. The aims of our study were to evaluate the effects of laparoscopic gastric bypass on calcium and vitamin D metabolism, and to identify patients at high risk to develop secondary hyperparathyroidism (HPT).
Methods
Serum calcium, alkaline phosphatase, intact parathyroid hormone (PTH), and 25-hydroxy (OH) vitamin D were measured at 3, 6, 12, and 24 months after laparoscopic gastric bypass in a cohort of morbidly obese women. Logistic regression was used in both univariate and multivariate models to identify independent preoperative variables associated with secondary HPT.
Results
The study enrolled 193 morbidly obese women. During the 2-year follow-up period, the incidence of elevated PTH levels (>65 pg/ml) was 53.3%. The mean time elapsed between surgery and detection of secondary HPT was 9.1 months (range, 3–24 months). Vitamin D deficiency was observed in 39 patients (20.2%). On univariate analysis, the preoperative factors associated with secondary HPT were race (high PTH levels were detected in 70% of African Americans versus 50% of Caucasians; p < 0.05), preoperative body mass index (BMI; high PTH: 52.5 ± 10.8 versus normal PTH: 48.9 ± 7.5 kg/m2; p < 0.01), and age (high PTH: 44.9 ± 9.2 versus normal PTH: 42.3 ± 9 years, p < 0.05). Race and age remained independent risk factors for secondary HPT in the multivariate logistic regression model after adjusting for the covariate Roux-limb length. African Americans were at more than 2.5 times greater risk to develop secondary HPT as Caucasian (RR 2.5; 95% CI: 1.03–6.17, p < 0.05). Patients older than 45 years were at 1.8 times higher risk of developing secondary HPT as their younger counterparts (RR 1.8; 95% CI: 1.01–3.32, p < 0.05).
Conclusions
Morbidly obese women have a high incidence of elevated PTH levels after gastric bypass surgery. Low vitamin D levels did not constitute the only reason behind this finding. African-American women and women older than 45 years of age were at significantly higher risk of developing secondary HPT. In these populations, aggressive supplementation with calcium citrate and vitamin D should be implemented.
Similar content being viewed by others
References
Bano G, Rodin DA, Pazianas M, Nussey SS (1999) Reduced bone mineral density after surgical treatment for obesity. Int J Obes Relat Metab Disord 23: 361–365
Bell NH (1985) Vitamin D-endocrine system. J Clin Invest 76: 1–6
Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S (1985) Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest 76: 370–373
Coates PS, Fernstrom JD, Fernstrom MH, Schauer PR, Greenspan SL (2004) Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab 89: 1061–1065
Compston JE, Vedi S, Ledger JE, Webb A, Gazet JC, Pilkington TR (1981) Vitamin D status and bone histomorphometry in gross obesity. Am J Clin Nutr 34: 2359–2363
Crowley LV, Seay J, Mullin G (1984) Late effects of gastric bypass for obesity. Am J Gastroenterol 79: 850–860
Diniz Mde F, Diniz MT, Sanches SR, Salgado PP, Valadao MM, Araujo FC, Martins DS, Rocha AL (2004) Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg 14: 1222–1226
El-Kadre LJ, Rocha PR, de Almeida Tinoco AC, Tinoco RC (2004) Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic Roux-en-Y gastric bypass. Obes Surg 14: 1062–1066
Giusti V, Gasteyger C, Suter M, Heraief E, Gaillard RC, Burckhardt P (2005) Gastric banding induces negative bone remodelling in the absence of secondary hyperparathyroidism: potential role of serum C telopeptides for follow-up. Int J Obes (Lond) 29: 1429–1435
Glass AR (1989) Endocrine aspects of obesity. Med Clin North Am 73:139–160
Goode LR, Brolin RE, Chowdhury HA, Shapses SA (2004) Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res 12: 40–47
Grados F, Brazier M, Kamel S, Mathieu M, Hurtebize N, Maamer M, Garabedian M, Sebert JL, Fardellone P (2003) Prediction of bone mass density variation by bone remodeling markers in postmenopausal women with vitamin D insufficiency treated with calcium and vitamin D supplementation. J Clin Endocrinol Metab 88: 5175–5179
Guney E, Kisakol G, Ozgen G, Yilmaz C, Yilmaz R, Kabalak T (2003) Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg 13: 383–388
Hamoui N, Anthone G, Crookes PF (2004) Calcium metabolism in the morbidly obese. Obes Surg 14: 9–12
Hamoui N, Kim K, Anthone G, Crookes PF (2003) The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg 138: 891–897
Harris SS (2006) Vitamin D and African Americans. J Nutr 136: 1126–1129
Johnson JM, Maher JW, Demaria EJ, Downs RW, Wolfe LG, Kellum JM (2006) The long-term effects of gastric bypass on vitamin D metabolism. Ann Surg 243: 701–705
Liel Y, Ulmer E, Shary J, Hollis BW, Bell NH (1988) Low circulating vitamin D in obesity. Calcif Tissue Int 43: 199–201
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22: 477–501
Madan AK, Orth WS, Tichansky DS, Ternovits CA (2006) Vitamin and trace mineral levels after laparoscopic gastric bypass. Obes Surg 16: 603–606
Pugnale N, Giusti V, Suter M, Zysset E, Heraief E, Gaillard RC, Burckhardt P (2003) Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes Relat Metab Disord 27: 110–116
Sanchez-Hernandez J, Ybarra J, Gich I, De Leiva A, Rius X, Rodriguez-Espinosa J, Perez A (2005) Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study. Obes Surg 15: 1389–1395
Shapes S BP, Dawson-Hughes B (2001) Weight Loss and the Skeleton. Nutritional Aspects of Osteoporosis. New York, Springer-Verlag
Snijder MB, van Dam RM, Visser M, Deeg DJ, Dekker JM, Bouter LM, Seidell JC, Lips P (2005) Adiposity in relation to vitamin D status and parathyroid hormone levels: a population-based study in older men and women. J Clin Endocrinol Metab 90: 4119–4123
Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72: 690–693
Ybarra J, Sanchez-Hernandez J, Gich I, De Leiva A, Rius X, Rodriguez-Espinosa J, Perez A (2005) Unchanged hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg 15: 330–335
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Youssef, Y., Richards, W.O., Sekhar, N. et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc 21, 1393–1396 (2007). https://doi.org/10.1007/s00464-007-9228-6
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9228-6