Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbid
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ORIGINAL ARTICLE
Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women Sotirios Volonakis 1 & Vasiliki Koika 1 & George Tzavelas 2 & Marina Skopeliti 1 & George Skroubis 3 & Fotis Kalfarentzos 3 & Theodore Alexandrides 1 Received: 5 June 2020 / Accepted: 16 October 2020 # Hellenic Endocrine Society 2020
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. Keywords Vitamin D . Obesity . Bariatric surgery . Secondary hyperparathyroidism . Bone mass
* Theodore Alexandrides [email protected]
George Skroubis [email protected]
Sotirios Volonakis [email protected] Vasiliki Koika [email protected]
Fotis Kalfarentzos [email protected] 1
Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504 Rio, Greece
George Tzavelas [email protected]
2
Department of Radiology, School of Medicine, University of Patras, 26504 Rio, Greece
Marina Skopeliti [email protected]
3
Department of Surgery, School of Medicine, University of Patras, 26504 Rio, Greece
Hormones
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