Carrasco Fernando, Basfi-Fer Karen, Rojas Pamela, Valencia Alejandra, Csendes Attila, Codoceo Juana, Inostroza Jorge, Ruz Manuel
Department of Nutrition, Faculty of Medicine, University of Chile, Independencia 1027, 8380453, Santiago, Chile.
Obes Surg. 2014 Jun;24(6):877-84. doi: 10.1007/s11695-014-1179-0.
A major long-term concern after gastric bypass (GBP) is the risk of osteoporosis; however, little is known about this complication in patients undergoing sleeve gastrectomy (SG).
To evaluate changes in bone mineral density (BMD) after GBP and SG, and its relationship with changes in vitamin D, parathyroid hormone (PTH), ghrelin, and adiponectin.
Twenty-three women undergoing GBP (BMI 42.0 ± 4.2 kg/m2; 37.3 ± 8.1 years) and 20 undergoing SG (BMI 37.3 ± 3.2 kg/m2; 34.2 ± 10.2 years) were studied before and 6 and 12 months after surgery. BMD was measured by dual-energy X-ray absorptiometry. Plasma PTH, 25-hydroxyvitamin D (25-OHD), ghrelin, and adiponectin concentrations were determined. Food as well as calcium and vitamin D supplement intake was recorded.
Excess weight loss (mean ± SE), adjusted by baseline excess weight, was 79.1±3.8% and 74.9 ± 4.1% 1 year after GBP and SG, respectively (p = 0.481). Significant reduction in BMD for total body (TB), lumbar spine (LS), and femoral neck (FN) was observed after GBP. In the SG group, reduction in BMD was significant only for TB. Adjusted by baseline BMD, the difference between change in BMD for GBP vs. SG was not significant for TB, LS, or FN. Percent reduction in ghrelin concentration was a main factor related to total BMD loss (GBP group) and LS BMD loss (GBP and SG groups).
One year after gastric bypass, bone mineral density was significantly affected, mainly at the femoral neck. Decreases in bone mineral density were more dramatic among patients who had greater baseline BMD and greater reduction in ghrelin concentrations.
胃旁路手术（GBP）后一个主要的长期担忧是骨质疏松风险；然而，对于接受袖状胃切除术（SG）的患者的这种并发症知之甚少。
评估GBP和SG术后骨矿物质密度（BMD）的变化，及其与维生素D、甲状旁腺激素（PTH）、胃饥饿素和脂联素变化的关系。
对23例行GBP的女性（BMI 42.0±4.2kg/m²；37.3±8.1岁）和20例行SG的女性（BMI 37.3±3.2kg/m²；34.2±10.2岁）在手术前、术后6个月和12个月进行研究。采用双能X线吸收法测量BMD。测定血浆PTH、25-羟维生素D（25-OHD）、胃饥饿素和脂联素浓度。记录食物以及钙和维生素D补充剂的摄入量。
以基线超重进行校正后，GBP和SG术后1年的超重减轻（均值±标准误）分别为79.1±3.8%和74.9±4.1%（p=0.481）。GBP术后全身（TB）、腰椎（LS）和股骨颈（FN）的BMD显著降低。在SG组中，仅TB的BMD降低显著。以基线BMD进行校正后，GBP与SG的BMD变化差异在TB、LS或FN方面不显著。胃饥饿素浓度的降低百分比是与总BMD丢失（GBP组）和LS BMD丢失（GBP和SG组）相关的主要因素。
胃旁路手术后1年，骨矿物质密度受到显著影响，主要是在股骨颈。基线BMD较高且胃饥饿素浓度降低幅度较大的患者中，骨矿物质密度的降低更为显著。
