Bone Mineral Density, Parathyroid Hormone , and Vitamin D A fter Gastric Bypass Surgery: a 10-Year Longitudinal Follow-U
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ORIGINAL CONTRIBUTIONS
Bone Mineral Density, Parathyroid Hormone, and Vitamin D After Gastric Bypass Surgery: a 10-Year Longitudinal Follow-Up Mustafa Raoof 1
&
Ingmar Näslund 1 & Eva Rask 2 & Eva Szabo 1
Received: 16 March 2020 / Revised: 4 August 2020 / Accepted: 10 August 2020 # The Author(s) 2020
Abstract Background The aim of the present study was to study longitudinal changes in bone mineral density (BMD), vitamin D, and parathyroid hormone (PTH) levels in females over a 10-year period after laparoscopic Roux-en-Y gastric bypass (LRYGB). Methods Twenty-three women, mean age 43.4 ± 8.7 years and mean body mass index (BMI) 44.6 ± 5.17 kg/m2 at baseline, were included. BMD, BMI, S-calcium, S-25(OH)-vitamin D, and fP-PTH were measured preoperatively and 2, 5, and 10 years postoperatively. Results Ten years after surgery, BMD of the spine and femoral neck decreased by 20% and 25%, respectively. Changes in serum levels of vitamin D, PTH, and calcium over the same period were small. Conclusion After LRYGB with subsequent massive weight loss, a large decrease in BMD of the spine and femoral neck was seen over a 10-year postoperative period. The fall in BMD largely occurred over the first 5 years after surgery. Keywords Bone mineral density . Gastric bypass . BMI . Parathyroid hormone . Obesity . Vitamin D . Bone health
Introduction Obesity continues to increase in developed countries and even more so in developing countries. In Europe, the estimated prevalence of obesity among adults is 25%, and in Sweden the prevalence among women and men has reached 20% and 24% respectively [1]. Obesity is strongly associated with morbidity and mortality [2, 3]. Surgery is the most effective treatment for obesity, resulting in sustained weight loss [4, 5]. Gastric bypass is a commonly performed procedure worldwide, including Sweden [6, 7]. Though obesity constitutes a considerable health threat, these patients have increased bone mineral density compared with persons with normal weight status [8]. Bariatric procedures, in particular those based on malabsorption, lead to a fall in bone mineral density (BMD) [9–12], an increase in bone resorption and bone remodeling, and changes in bone histomorphometry parameters [10, 13, * Mustafa Raoof [email protected] 1
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
2
Department of Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
14]. The risk for fracture increases at several skeletal sites after bariatric surgery [15–17]. These changes in bone metabolism seem not to be the result of weight loss alone, since BMD continues to decline even when the patient’s weight has stabilized [18]. Vitamin D deficiency [19–23] and secondary hyperparathyroidism [24, 25] could be important in this context; however, the long-term effects of gastric bypass surgery on the skeleton remain unclear. The aim of this prospective study was to follow a group of female patients longitudinally over a 10-year period after laparosco
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