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Gastric Bypass Surgery for Morbid Obesity Leads to an Increase in Bone Turnover and a Decrease in Bone Mass

Osteoporosis Prevention and Treatment Center (P.S.C., S.L.G.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; University of Pittsburgh Medical Center Health System Weight Management Center, and Department of Psychiatry (J.D.F., M.H.F.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; and Department of Surgery, University of Pittsburgh, Minimally Invasive Surgical Center (P.R.S.), Magee-Women’s Hospital, Pittsburgh, Pennsylvania 15213

Little is known about the effects on the skeleton of laparoscopic Roux-en-Y gastric bypass (LRGB) surgery for morbid obesity and subsequent weight loss. We compared 25 patients who had undergone LRGB 11 ± 3 months previously with 30 obese controls matched for age, gender, and menopausal status. Compared with obese controls, patients post LRGB had significantly lower weight (92 ± 16 vs. 133 ± 20 kg; P < 0.001) and body mass index (31 ± 5 vs. 48 ± 7 kg/m²; P < 0.001). Markers of bone turnover were significantly elevated in patients post LRGB compared with controls (urinary N-telopeptide cross-linked collagen type 1, 93 ± 38 vs. 24 ± 11 nmol bone collagen equivalents per mmol creatinine; and osteocalcin, 11.6 ± 3.4 vs. 7.6 ± 3.6 ng/ml; both P < 0.001). Fifteen patients were studied prospectively for an average of 9 months after LRGB. They lost 37 ± 9 kg and had a 29 ± 8% fall in body mass index (both P < 0.001). Urinary N-telopeptide cross-linked collagen type 1 increased by 174 ± 168% at 3 months (P < 0.01) and 319 ± 187% at 9 months (P < 0.01). Bone mineral density decreased significantly at the total hip (7.8 ± 4.8%; P < 0.001), trochanter (9.3 ± 5.7%; P < 0.001), and total body (1.6 ± 2.0%; P < 0.05), with significant decreases in bone mineral content at these sites.

In summary, within 3 to 9 months after LRGB, morbidly obese patients have an increase in bone resorption associated with a decrease in bone mass. Additional studies are needed to examine these findings over the longer term.

Address all correspondence and requests for reprints to: Susan L. Greenspan, M.D., Director, Osteoporosis Prevention and Treatment Center, University of Pittsburgh, 3471 Fifth Avenue, Suite 1110, Pittsburgh, Pennsylvania, 15213-3221. E-mail: griffithsd{at}msx.dept-med.pitt.edu.

This work was supported by a grant from the Obesity and Nutrition Research Center, University of Pittsburgh (Pittsburgh, PA); by Grant M01-RR00056-39 from the National Institutes of Health/National Center for Research Resources to the General Clinical Research Center, University of Pittsburgh; and by the University of Pittsburgh Medical Center Health System Weight Management Center Fund.

Abbreviations: BMC, Bone mineral content; BMD, bone mineral density; BMI, body mass index; BSAP, bone-specific alkaline phosphatase; BUA, broadband ultrasound attenuation; CV, coefficient(s) of variation; DXA, dual-energy x-ray absorptiometry; LRGB, laparoscopic Roux-en-Y gastric bypass; NTx, N-telopeptide cross-linked collagen type 1; PA, posteroanterior.

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