Nutrigenetics and Nutrigenomics Laboratory, Instituto Nacional de Medicina Genómica, Periférico Sur 4809, Arenal Tepepan, Tlalpan, CP 14610 Mexico City, Mexico.
Universidad Autónoma Metropolitana Unidad Xochimilco, Calzada del Hueso 1100, Villa Quietud, Coyoacán, CP 04960 Mexico City, Mexico.
Int J Surg. 2014;12(9):976-82. doi: 10.1016/j.ijsu.2014.08.002. Epub 2014 Aug 8.
Bone regulation system may be affected after bariatric surgeries, but procedures impact differently to bone mineral density (BMD) and measures restraining bone loss are frequently neglected until clinical consequences become manifest. This is a systematic review aimed to elucidate whether BMD loss is comparable after different bariatric surgeries.
A search of morbid obese adults, undergone to bariatric surgery, with BMD measured by dual-energy X-ray absorptiometry at baseline and after surgery studies was performed in several databases. Studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement and COCHRANE Risk of Bias tool. The random model was selected for meta-analysis; heterogeneity was analyzed with T(2), inconsistency (I(2) > 50%) and Chi(2) (p < 0.10). Level of evidence and strength of recommendations were summarized using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE System).
Twelve studies met the selection criteria. After one year, reduction in total BMD in patients with mixed surgical procedures was significant: -0.03 g/cm(2) (CI 95% 0.00 to -0.06, p < 0.05). BMD was reduced by -0.12 g/cm(2) (CI 95% -0.10 to -0.15, p < 0.001) in the hip, -0.07 g/cm(2) (CI 95% -0.03 to -0.11, p < 0.001) in the column, and -0.03 g/cm(2) (IC 95% -0.02 to -0.04, p < 0.001) in the forearm, but not in restrictive surgeries. Studies included showed high heterogeneity and low quality of evidence.
Patients undergone to mixed bariatric surgery had significant higher BMD deterioration as demonstrated in this review, suggesting that more attention for preventing fractures is required.
减重手术后骨调节系统可能会受到影响，但不同的手术程序对骨密度（BMD）的影响不同，而且通常会忽视限制骨质流失的措施，直到出现临床后果。这是一项系统评价，旨在阐明不同减重手术后是否会出现 BMD 丢失。
在多个数据库中对接受过减重手术的病态肥胖成年人进行了搜索，这些研究均使用双能 X 射线吸收法在基线和手术后测量了 BMD。使用观察性研究的强化报告标准（STROBE）声明和 Cochrane 偏倚风险工具对研究进行了评估。对于荟萃分析，选择了随机模型；使用 T(2)、不一致性（I(2)＞50%）和 Chi(2)（p＜0.10）分析异质性。使用推荐评估、制定与评价（GRADE）系统总结证据水平和推荐强度。
符合选择标准的有 12 项研究。1 年后，混合手术患者的总 BMD 显著降低：-0.03 g/cm(2)（95%CI 0.00 至-0.06，p＜0.05）。髋关节 BMD 降低了-0.12 g/cm(2)（95%CI-0.10 至-0.15，p＜0.001），柱部降低了-0.07 g/cm(2)（95%CI-0.03 至-0.11，p＜0.001），前臂降低了-0.03 g/cm(2)（95%CI-0.02 至-0.04，p＜0.001），但在限制手术中没有降低。纳入的研究显示存在高度异质性和低质量证据。
本研究表明，接受混合减重手术的患者 BMD 恶化程度显著更高，这表明需要更加关注预防骨折。
