Department of Medicine, Division of Medicine, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.
Obesity (Silver Spring). 2011 Dec;19(12):2388-93. doi: 10.1038/oby.2011.133. Epub 2011 May 26.
The objective of this study was to characterize changes in metabolic bone parameters following bariatric surgery. Seventy-three obese adult patients who underwent either gastric banding (GB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS) were followed prospectively for 18 months postoperatively. Changes in the calcium-vitamin D axis (25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), calcium, parathyroid hormone (PTH)), markers of bone formation (osteocalcin, bone-specific alkaline phosphatase) and resorption (urinary N-telopeptide (NTx)), as well as bone mineral density (BMD) were assessed at 3-month intervals during this time period. Bariatric surgery resulted in significant and progressive weight loss over 18 months. With supplementation, 25OHD levels increased 65.3% (P < 0.0001) by 3 months, but leveled off and decreased <30 ng/ml by 18 months. PTH initially decreased 21.4% (P = 0.01) at 3 months, but later approached presurgery levels. 1,25(OH)(2)D increased significantly starting at month 12 (50.3% increase from baseline, P = 0.008), and was positively associated with PTH (r = 0.82, P = 0.0001). When stratified by surgery type, median PTH and 1,25(OH)(2)D levels were higher following combined restrictive and malabsorptive operations (RYGB and BPD/DS) compared to GB. Bone formation/resorption markers were increased by 3 months (P < 0.05) and remained elevated through 18 months. Radial BMD decreased 3.5% by month 18, but this change was not significant (P = 0.23). Our findings show that after transient improvement, preoperative vitamin D insufficiency and secondary hyperparathyroidism persisted following surgery despite supplementation. Postoperative secondary hyperparathyroidism was associated with increased 1,25(OH)(2)D levels and increased bone turnover markers.
本研究的目的是描述减重手术后代谢性骨参数的变化。73 例肥胖成年患者分别接受胃带术（GB）、Roux-en-Y 胃旁路术（RYGB）或胆胰分流十二指肠转位术（BPD/DS），术后随访 18 个月。在此期间，每隔 3 个月评估一次钙-维生素 D 轴（25-羟维生素 D（25OHD）、1,25-二羟维生素 D（1,25(OH)(2)D）、钙、甲状旁腺激素（PTH））、骨形成标志物（骨钙素、骨碱性磷酸酶）和吸收标志物（尿 N-端肽（NTx））以及骨密度（BMD）的变化。减重手术后 18 个月体重持续显著下降。补充后，25OHD 水平在 3 个月时增加 65.3%（P<0.0001），但在 18 个月时降至<30ng/ml。PTH 最初在 3 个月时降低 21.4%（P=0.01），但后来接近术前水平。1,25(OH)(2)D 从第 12 个月开始显著增加（从基线增加 50.3%，P=0.008），与 PTH 呈正相关（r=0.82，P=0.0001）。按手术类型分层时，RYGB 和 BPD/DS 等联合限制和吸收不良手术（RYGB 和 BPD/DS）后的 PTH 和 1,25(OH)(2)D 水平中位数均高于 GB。骨形成/吸收标志物在 3 个月时增加（P<0.05），并持续升高至 18 个月。桡骨 BMD 在第 18 个月时下降 3.5%，但无统计学意义（P=0.23）。我们的研究结果表明，尽管进行了补充，但术后术前维生素 D 不足和继发性甲状旁腺功能亢进症在手术后仍会短暂改善。术后继发性甲状旁腺功能亢进症与 1,25(OH)(2)D 水平升高和骨转换标志物升高有关。
