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Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study

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Abstract

Purpose

Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years.

Materials and Methods

Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm2).

Results

We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118–1.256) and in total proximal femur (OR=1.158; 95% CI 1.066–1.258), both after adjusting for follow-up and excess weight loss.

Conclusion

After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.

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Funding

This study was partly funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES - Finance Code 001) and Research Incentive Fund of the Hospital de Clínicas de Porto Alegre (FIPE). LFS received grants from Programa Especial para Doutorado em Pesquisa Médica (PDE-DPM) by CAPES.

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Authors and Affiliations

  1. Post-Graduate Program in Medical Sciences – Endocrinology (PPG ENDO), Universidade Federal do Rio Grande do Sul, (UFRGS), Porto Alegre, Brazil

    Luiza Ferreira Sperb

  2. Statistics Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil

    Vanessa Bielefeldt Leotti

  3. Department of Internal Medicine – Endocrinology Division, HCPA and Faculty of Medical Sciences (FAMED/UFRGS), Porto Alegre, Brazil

    Sandra Pinho Silveiro, Mirela Jobim de Azevedo & Luciana Verçoza Viana

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  1. Luiza Ferreira Sperb
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  4. Mirela Jobim de Azevedo
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Correspondence to Luiza Ferreira Sperb.

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Ethical Approval and Informed Consent

The study was approved by the Research Ethics Committee of HCPA, and data were collected from electronic medical records in accordance with the term of commitment for data use. This term is issued by the participant hospital as a means of certifying the commitment of the researchers in preserving the privacy of patients whose data will be collected in electronic medical records and database of the institution, ensuring that information can only be disclosed anonymously. For this type of study, formal consent is not required, and informed consent does not apply.

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Key Points

• Hypovitaminosis D and SHPT are highly prevalent in late post-bariatric patients.

• Micronutrient supplementation seems to be insufficient in preventing bone disease.

• Low BMD is more related to age, sex, and menopausal status in femoral locations.

• Osteometabolic disease post-RYGB should be carefully studied and monitored.

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Sperb, L.F., Leotti, V.B., Silveiro, S.P. et al. Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study. OBES SURG 33, 911–919 (2023). https://doi.org/10.1007/s11695-022-06448-4

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