Department of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal, Carretera de Colmenar Km. 9.1, Madrid, Spaine.
Obes Surg. 2010 Apr;20(4):468-73. doi: 10.1007/s11695-009-0028-z.
Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD).
Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD.
BPD patients showed significantly higher PTH, osteocalcin, and beta-CTx levels than controls. In the multivariate regression analysis, only PTH (beta=0.42; P=0.0002), menopausal status (beta=0.31; P=0.007) and the percentage of lost BMI (beta=-0.24; P=0.03) significantly predicted the osteocalcin level (R2=0.33; F=9.56; P<0.0001). Similarly, only PTH (beta=0.39; P=0.0005), menopausal status (beta=0.37; P=0.001) and the percentage of lost BMI (beta=-0.23; P=0.04) significantly predicted the beta-CTx level (R2=0.33; F=9.82; P<0.0001). Osteocalcin and beta-CTx levels correlated negatively with BMD at lumbar spine (r=-0.38, P=0.002 and r=-0.30, P=0.02, respectively).
Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.
胆胰分流术（BPD）是最有效的减肥手术。大约 70%的此类患者由于钙和维生素 D 吸收不良，长期患有继发性甲状旁腺功能亢进症（SH）。这项工作旨在研究 SH 对骨转换的影响及其与骨密度（BMD）的关系。
测定了 63 例 BPD 患者和 34 例病态肥胖对照者的骨转换标志物。在 BPD 组中，我们还研究了年龄、体重减轻、共同通道长度、PTH、维生素 D 和血清钙对骨转换的影响，以及与 BMD 的关系。
BPD 患者的 PTH、骨钙素和β-CTX 水平明显高于对照组。多元回归分析显示，只有 PTH（β=0.42；P=0.0002）、绝经状态（β=0.31；P=0.007）和体重减轻的 BMI 百分比（β=-0.24；P=0.03）显著预测骨钙素水平（R2=0.33；F=9.56；P<0.0001）。同样，只有 PTH（β=0.39；P=0.0005）、绝经状态（β=0.37；P=0.001）和体重减轻的 BMI 百分比（β=-0.23；P=0.04）显著预测β-CTX 水平（R2=0.33；F=9.82；P<0.0001）。骨钙素和β-CTX 水平与腰椎 BMD 呈负相关（r=-0.38，P=0.002 和 r=-0.30，P=0.02）。
慢性 SH 和体重减轻决定了骨转换率的增高，这与 BPD 患者的 BMD 下降有关。
