Journal Article

Longitudinal 5-year evaluation of bone density and microarchitecture after Roux-en-Y gastric bypass surgery

Greenblatt, Logan B, Bouxsein, Mary L, Finkelstein, Joel S, Lindeman, Katherine G, Rourke, Caroline, Yu, Elaine W

2018

Overview

Bone health declines in the initial years after Roux-en-Y gastric bypass (RYGB), but long-term skeletal effects are unclear. To document longitudinal changes in bone mineral density (BMD) and microarchitecture 5 years after RYGB. Prospective 5-year observational study of 21 adults with severe obesity receiving RYGB at an academic medical center. Spine and hip areal BMD were measured by dual-energy X-ray absorptiometry, and trabecular volumetric BMD (vBMD) of the spine was assessed by quantitative CT (QCT). We measured vBMD and microarchitecture of the distal radius and tibia by high-resolution peripheral QCT in a subset of subjects. Serum type I collagen C-terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (P1NP) were also measured. Areal BMD declined by -7.8% ± 7.6% at the spine and -15.3% ± 6.3% at the total hip by 5 years after RYGB (P ≤ 0.001), although the rate of bone loss slowed in later years. Trabecular spine vBMD decreased by -12.1% ± 12.3% by 5 years (P ≤ 0.001). At peripheral sites, vBMD continued to decrease steadily throughout 5 years, with parallel declines in cortical and trabecular microarchitecture, leading to decreases in estimated failure load of -20% and -13% at the radius and tibia, respectively (P < 0.001). Five years after RYGB, CTX and P1NP were 150% and 34% above baseline (P < 0.001 and P = 0.017, respectively). Sustained high-turnover bone loss and bone microarchitectural deterioration occur in the 5 years after RYGB. Adults receiving RYGB warrant assessment of bone health.

• Publisher: Copyright Oxford University Press,Oxford University Press,Endocrine Society
• Subject: Absorptiometry, Photon / Adult / Bone density / Bone Density - physiology / Bone Diseases, Metabolic - diagnostic imaging / Bone Diseases, Metabolic - epidemiology / Bone Diseases, Metabolic - etiology / Bone Diseases, Metabolic - physiopathology / Bone loss / Bone mineral density / Bone Remodeling - physiology / Bone surgery / Bone turnover / Clinical s / Collagen (type I) / Dual energy X-ray absorptiometry / Female / Gastric bypass / Gastric Bypass - adverse effects / Gastric Bypass - methods / Gastrointestinal surgery / Hip / Humans / Longitudinal Studies / Male / Middle Aged / Obesity, Morbid - surgery / Pelvic Bones - diagnostic imaging / Pelvic Bones - physiopathology / Procollagen / Prospective Studies / Radius / Radius - diagnostic imaging / Radius - physiopathology / Spine - diagnostic imaging / Spine - physiopathology / Tibia / Tibia - diagnostic imaging / Tibia - physiopathology / Tomography, X-Ray Computed