Endocrinology Service, Hospital Universitario de Bellvitge, Barcelona, Spain.
Obes Surg. 2009 Jul;19(7):860-6. doi: 10.1007/s11695-009-9843-5. Epub 2009 May 2.
In patients undergoing gastric bypass, massive weight loss and impairment of calcium intake and absorption in the duodenum and proximal jejunum may increase the risk of bone mass loss and fractures. However, few data are available regarding the impact of this surgery on the skeleton. The aim of our study was to examine the skeletal changes in a cohort of morbidly obese Caucasian women during the first year after gastric bypass and to analyse the factors implicated in the development of bone loss.
Sixty-two morbidly obese white women aged 45.3 +/- 8.9 years were studied. Anthropometric measurements, bone mineral density (BMD) screening using dual-energy X- ray absorptiometry and plasma determinations of calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH) D(3)] and insulin-like growth factor-I (IGF-I) were made prior to and 12 months after surgery.
A year after surgery, BMD significantly decreased at the femoral neck (10.2 +/- 5.7%) and at the lumbar spine (3.2 +/- 4.4%). In the follow-up, 16.1% of women had osteopenia at the femoral neck and 19.3% at the lumbar spine, and 1.6% developed osteoporosis at the lumbar spine. Patients with bone disease were significantly older; the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. However, no differences in body mass index, weight loss, fat mass, calcium, PTH, 25(OH) D(3) or IGF-I values were found between groups. In the logistic regression analysis, lean mass 12 months after surgery and menopause were found to be the main determinants of osteopenia after adjusting for age with odds ratios of 0.82 and 9.13, respectively.
There is a significant BMD loss at the femoral neck and lumbar spine a year after gastric bypass. Menopausal patients and those with greater lean mass loss are at greater risk and, consequently, should be closely followed up with periodic densitometries.
在接受胃旁路手术的患者中，大量的体重减轻以及十二指肠和空肠近端钙摄入和吸收的受损可能会增加骨量丢失和骨折的风险。然而，关于这种手术对骨骼的影响的数据很少。我们的研究目的是在胃旁路手术后的第一年检查一组肥胖白人女性的骨骼变化，并分析导致骨丢失的因素。
研究了 62 名年龄为 45.3 ± 8.9 岁的肥胖白人女性。在手术前和手术后 12 个月，进行了人体测量学测量、双能 X 射线吸收法（DXA）筛查骨密度（BMD）以及血浆钙、磷、甲状旁腺激素（PTH）、25-羟维生素 D [25（OH）D（3）]和胰岛素样生长因子-I（IGF-I）的测定。
手术后 1 年，股骨颈（10.2 ± 5.7%）和腰椎（3.2 ± 4.4%）的 BMD 显著下降。在随访中，16.1%的女性股骨颈骨密度降低，19.3%的女性腰椎骨密度降低，1.6%的女性腰椎骨质疏松症。患有骨病的患者年龄明显较大；该组中绝经后妇女的比例较高，瘦体重的初始和最终值均较低。然而，两组间的体重指数、体重减轻、脂肪量、钙、PTH、25（OH）D（3）或 IGF-I 值均无差异。在逻辑回归分析中，手术后 12 个月的瘦体重和绝经是调整年龄后的骨质疏松症的主要决定因素，其优势比分别为 0.82 和 9.13。
胃旁路手术后 1 年，股骨颈和腰椎的 BMD 明显丢失。绝经后患者和瘦体重丢失较多的患者风险更高，因此应密切随访，定期进行骨密度检查。
