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Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women

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Abstract

Objectives

The objective of this study is to investigate the effect of adequate vitamin D supplementation on bone mineral density (BMD) following long limb-biliopancreatic diversion (LL-BPD), a malabsorptive bariatric operation.

Background

Marked weight loss following bariatric surgery is associated with significant decrease in BMD, attributed to the weight loss and to nutritional, mineral, and vitamin D deficiencies resulting in secondary hyperparathyroidism.

Methods

Two groups, of 35 and 37 healthy, obese (BMI, 50.4 + 6.6 and 46.5 + 4.8 g/cm2), premenopausal, normally menstruating women underwent LL-BPD. Both groups received high-calcium diets, 600 IU of vitamin D, and 1000 mg elemental calcium daily, while group B received an extra dose of vitamin D (10,000 IU/day) during the first postoperative month, followed by dose adjustment in order to maintain 25OHD concentration higher than 30 μg/L. Areal BMD (aBMD) was measured at the lumbar spine preoperatively and 1 year postoperatively.

Results

One year postoperatively, BMI decreased by approximately 19 kg/m2 in both groups, while 25-OH-vitamin D levels did not change in group A (18.7 + 9.1 to 20.2 + 13.0 μg/L, (p = 0.57)) and increased in group B (15.58 ± 5.73 to 52.97 ± 15.46 μg/L, (p = < 0.001). PTH levels increased in group A (from 38.5 ± 12.2 to 51.2 ± 32.8 pg/ml) (p = 0.047) and decreased in group B (from 51.61 ± 18.7 to 45.1 ± 17.8 pg/ml) (p = 0.042). Lumbar spine aBMD decreased similarly in both groups (p = 0.311, for the comparison between groups) from 1.198 + 0.14 to 1.103 + 0.15 g/cm2 in group A (p < 0.001) and from 1.157 + 0.14 to 1.076 + 0.14 g/cm2 in group B (p < 0.001) and Z-score from 0.93 + 0.97 to 0.19 + 1.02, (p < 0.001) and from 1.15 + 1.29 to 0.419 + 1.28, (p < 0.001), respectively.

Conclusions

LL-BPD leads to similar and significant bone mass reduction 1 year postoperatively, irrespective of adequate vitamin D replacement and in the absence of secondary hyperparathyroidism.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece

    Sotirios Volonakis, Vasiliki Koika, Marina Skopeliti & Theodore Alexandrides

  2. Department of Radiology, School of Medicine, University of Patras, 26504, Rio, Greece

    George Tzavelas

  3. Department of Surgery, School of Medicine, University of Patras, 26504, Rio, Greece

    George Skroubis & Fotis Kalfarentzos

Authors
  1. Sotirios Volonakis
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  2. Vasiliki Koika
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  3. George Tzavelas
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  4. Marina Skopeliti
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  5. George Skroubis
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  6. Fotis Kalfarentzos
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  7. Theodore Alexandrides
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Correspondence to Theodore Alexandrides.

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Ethical approval

The study was approved by the Ethical Committee of the University Hospital of Patras, Greece.

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All patients were informed of the nature, risks, and benefits of the study and provided written informed consent before enrolling in the study.

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Volonakis, S., Koika, V., Tzavelas, G. et al. Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women. Hormones 20, 315–321 (2021). https://doi.org/10.1007/s42000-020-00254-2

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