Gómez José Manuel, Vilarrasa Núria, Masdevall Carles, Pujol Jordi, Solano Esther, Soler Juan, Elio Iñaki, Gallart Lluis, Vendrell Joan
CIBERDEM, Endocrinology Service, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Obes Surg. 2009 Mar;19(3):345-50. doi: 10.1007/s11695-008-9529-4. Epub 2008 Apr 29.
The mechanisms by which increased body weight influence bone mass density (BMD) are still unknown. The aim of our study was to analyze the relationship between anthropometric and body composition variables, insulin growth factor-I (IGF-I), adiponectin and soluble tumor necrosis factor-alpha receptors (sTNFR) 1 and 2 with BMD in two cohorts of morbid obese patients, before and after bypass surgery.
The first cohort included 25 women aged 48+/-7.6 years studied before bypass surgery. The second included 41 women aged 46+/-9.2 years, 12 months after surgery. We studied anthropometric variables obtained from whole body DEXA composition analysis. Serum IGF-I, intact serum parathyroid hormone, 25-hydroxivitamin D3, plasma adiponectin concentrations, sTNFR1, sTNFR2 concentrations were measured.
In the first cohort, the BMI was 44.5+/-3.6 kg/m2, parathyroid hormone, IGF-I, and adiponectin concentrations were lower, and sTNFR1 concentrations were higher than in the second cohort. In the multiple regression analysis, BMD remained significantly associated with body fat percentage (beta -0.154, p=0.01), lean mass (beta 0.057, p=0.016) and phosphate concentration (beta 0.225, p=0.05). In the second cohort, BMI was 31+/-5.1 kg/m2. In the multiple regression analysis, BMD remained significantly associated with lean mass (beta 0.006, p=0.03).
The inverse correlation found between body fat and BMD in the first cohort indicates morbid obesity increases the risk of osteoporosis and we found a positive correlation with lean and fat mass before bariatric surgery and with lean mass after bypass surgery.
体重增加影响骨密度（BMD）的机制尚不清楚。我们研究的目的是分析病态肥胖患者两个队列在旁路手术前后人体测量学和身体成分变量、胰岛素生长因子-I（IGF-I）、脂联素和可溶性肿瘤坏死因子-α受体（sTNFR）1和2与骨密度之间的关系。
第一个队列包括25名年龄在48±7.6岁的女性，在旁路手术前进行研究。第二个队列包括41名年龄在46±9.2岁的女性，在手术后12个月进行研究。我们研究了通过全身双能X线吸收法成分分析获得的人体测量学变量。测量血清IGF-I、完整血清甲状旁腺激素、25-羟基维生素D3、血浆脂联素浓度、sTNFR1、sTNFR2浓度。
在第一个队列中，BMI为44.5±3.6kg/m²，甲状旁腺激素、IGF-I和脂联素浓度较低，sTNFR1浓度高于第二个队列。在多元回归分析中，骨密度仍与体脂百分比（β -0.154，p = 0.01）、瘦体重（β 0.057，p = 0.016）和磷酸盐浓度（β 0.225，p = 0.05）显著相关。在第二个队列中，BMI为31±5.1kg/m²。在多元回归分析中，骨密度仍与瘦体重（β 0.006，p = 0.03）显著相关。
在第一个队列中发现体脂与骨密度呈负相关，表明病态肥胖增加骨质疏松风险，并且我们发现在减肥手术前骨密度与瘦体重和脂肪量呈正相关，在旁路手术后与瘦体重呈正相关。
