Bone and mineral metabolism in patients undergoing Roux-en-Y gastric bypass
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Springer-Verlag London Ltd
Abstract
Summary: Despite effective weight reduction, the impact of bariatric surgery on bone is a major concern. Mechanisms include decreased mechanical loading, calcium and vitamin D malabsorption, deficiency in other nutrients, and alterations in fat- and gut-derived hormones. The evidence to support clinical care pathways to prevent bone loss and fractures is at this point weak. Introduction: There is a growing concern regarding the potential deleterious impact of bariatric surgery on bone metabolism. This comprehensive review addresses this controversial topic. Methods: We reviewed and analyzed articles evaluating bone metabolism and mechanisms for the ensuing putative bone loss in adult patients exclusively undergoing Roux-en-Y gastric bypass (RYGB) surgery, for the period spanning 1942 till September 2012. Results: Mechanisms identified to contribute to alterations in bone metabolism after bypass surgery include: decreased mechanical loading, calcium and vitamin D malabsorption with secondary hyperparathyroidism, deficiency in other nutrients, in addition to alterations in adipokines, gonadal steroids, and gut-derived hormones favoring bone loss, with the exception of serotonin and glucagon-like peptide-1. The relative contribution of each of these hormones to changes in bone homeostasis after bypass surgery remains undefined. Bone loss reflected by a decline in bone mineral density (BMD) and an increase in bone turnover markers have been reported in many studies, limited for the most part by the exclusive use of dual energy X-ray absorptiometry. Well-designed long-term prospective trials with fractures as an outcome, and studies investigating the magnitude, reversibility, and impact of the observed metabolic changes on fracture outcomes are lacking. Conclusion: Robust conclusions regarding bone loss and fracture outcome after RYGB surgery cannot be drawn at this time. Although not evidence based, baseline evaluation and sequential monitoring with measurement of BMD and calciotropic hormones seem appropriate, with adequate calcium and vitamin D replacement. Beneficial interventions remain unclear. © International Osteoporosis Foundation and National Osteoporosis Foundation 2013.
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Keywords
Adipokines, Bone metabolism, Gut neuroendocrine hormones, Obesity, Roux-en-y gastric bypass, Biological markers, Bone and bones, Bone density, Gastric bypass, Hormones, Humans, Osteoporosis, Osteoporotic fractures, 25 hydroxyvitamin d, Adipocytokine, Adiponectin, Amino terminal telopeptide, Amylin, Androgen, Biological marker, Calcium, Carboxy terminal telopeptide, Estradiol, Estrogen, Fat, Gastric inhibitory polypeptide, Gastrointestinal hormone, Ghrelin, Glucagon like peptide 1, Insulin, Leptin, Magnesium, Osteocalcin, Peptide yy, Propranolol, Serotonin, Serotonin uptake inhibitor, Sex hormone, Steroid, Testosterone, Trace element, Unindexed drug, Vitamin d, Hormone, Apoptosis, Bariatric surgery, Body fat, Bone mass, Bone mineralization, Bone remodeling, Bone turnover, Cell proliferation, Dual energy x ray absorptiometry, Energy expenditure, Fracture, Gonad, Hormonal therapy, Human, Hyperinsulinemia, Insulin sensitivity, Intestine, Magnesium deficiency, Malabsorption, Medline, Mineral metabolism, Neuroendocrine system, Nonhuman, Nutrient, Nutritional deficiency, Osteoblast, Osteoclastogenesis, Osteolysis, Outcome assessment, Oxidative stress, Pathophysiology, Priority journal, Prospective study, Protein blood level, Protein urine level, Review, Risk factor, Roux en y gastric bypass, Roux y anastomosis, Secondary hyperparathyroidism, Serum, Small intestine, Stomach, Stomach bypass, Surgical anatomy, Surgical patient, Surgical risk, Systematic review, Testosterone blood level, Vitamin blood level, Vitamin d deficiency, Vitamin supplementation, Adverse effects, Bone, Metabolism, Physiology