Fleischer J, Stein E M, Bessler M, Della Badia M, Restuccia N, Olivero-Rivera L, McMahon D J, Silverberg S J
Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
J Clin Endocrinol Metab. 2008 Oct;93(10):3735-40. doi: 10.1210/jc.2008-0481. Epub 2008 Jul 22.
Bariatric surgery is common and may be associated with deleterious effects on the skeleton.
Our objective was to assess bone metabolism and bone mineral density (BMD) after Roux-en-Y gastric bypass.
We conducted a 1-yr prospective longitudinal study at a university hospital bariatric surgery practice and metabolic bone disease unit.
Participants included 23 obese (mean body mass index 47 kg/m(2)) men and women, aged 20-64 yr.
Serum PTH, 25-hydroxyvitamin D, osteocalcin, and urinary N-telopeptide, and BMD were assessed.
Patients lost 45 +/- 2 kg 1 yr postoperatively (P < 0.01). PTH increased early (3 months, 43-50 pg/ml; P < 0.001) and urinary calcium dropped (161-92 mg/24 h; P < 0.01), despite doubling of calcium intake (1318-2488 mg/d; P < 0.001). Serum 25-hydroxyvitamin D concentrations were unchanged (23-26 ng/ml), although vitamin D intake increased by 260% (658 IU/d at baseline to 1698 IU/d at 12 months; P < 0.05). Markers of bone remodeling rose (P < 0.01 for both urinary N-telopeptide and osteocalcin), whereas BMD decreased at the femoral neck (9.2%, P < 0.005) and at the total hip (8.0%, P < 0.005). These declines were strongly associated with the extent of weight loss (femoral neck: r = 0.90, P < 0.0001; and total hip: r = 0.65, P = 0.02). Lumbar spine and distal radius sites did not change.
After Roux-en-Y gastric bypass, there was evidence of calcium and vitamin D malabsorption. Bone turnover increased, and hip bone density rapidly declined. The decline in hip BMD was strongly associated with weight loss itself. Vigilance for nutritional deficiencies and bone loss in patients both before and after bariatric surgery is crucial.
减肥手术很常见，可能会对骨骼产生有害影响。
我们的目的是评估Roux-en-Y胃旁路术后的骨代谢和骨矿物质密度（BMD）。
我们在一家大学医院的减肥手术科室和代谢性骨病科进行了一项为期1年的前瞻性纵向研究。
参与者包括23名肥胖（平均体重指数47kg/m²）的男性和女性，年龄在20 - 64岁之间。
评估血清甲状旁腺激素（PTH）、25 - 羟基维生素D、骨钙素和尿N - 端肽以及BMD。
患者术后1年体重减轻45±2kg（P < 0.01）。尽管钙摄入量增加了一倍（从基线时的1318mg/d增加到12个月时的2488mg/d；P < 0.001），但PTH早期升高（3个月时，从43pg/ml升至50pg/ml；P < 0.001），尿钙下降（从161mg/24h降至92mg/24h；P < 0.01）。血清25 - 羟基维生素D浓度未变（23 - 26ng/ml），尽管维生素D摄入量增加了260%（从基线时的658IU/d增加到12个月时的1698IU/d；P < 0.05）。骨重塑标志物升高（尿N - 端肽和骨钙素均P < 0.01），而股骨颈BMD下降（降低9.2%，P < 0.005），全髋BMD下降（降低8.0%，P < 0.005）。这些下降与体重减轻程度密切相关（股骨颈：r = 0.90，P < 0.0001；全髋：r = 0.65，P = 0.02）。腰椎和桡骨远端部位未发生变化。
Roux - en - Y胃旁路术后，有证据表明存在钙和维生素D吸收不良。骨转换增加，髋部骨密度迅速下降。髋部BMD的下降与体重减轻本身密切相关。对减肥手术前后患者的营养缺乏和骨质流失保持警惕至关重要。
