Pizzorno Lara
Lara Pizzorno, md iv, ma , lmt , is senior medical editor at Integrative Medicine Advisers, LLC, in Seattle, Washington.
Integr Med (Encinitas). 2016 Apr;15(2):35-46.
As discussed in Part 1, obesity is now a global epidemic affecting a significant and rapidly increasing number of adults, adolescents, and children. As the incidence of obesity has increased, so has the use of bariatric surgery to treat it. A growing number of recently published studies have reported that, despite calcium and vitamin D supplementation, the most frequently performed types of bariatric surgery, the Roux-en-Y gastric bypass (RYGB) and the sleeve gastrectomy (SG), cause significant, ongoing bone loss. Recent studies investigating nutrient malabsorption and changes in a wide range of hormones that are induced by bariatric surgery have indicated that calcium malabsorption is just the tip of a formidable iceberg. Part 1 reviewed the latest research findings confirming that the prevalence of obesity is, in fact, skyrocketing and that bariatric surgery causes ongoing accelerated bone loss. Part 1 also discussed the mechanisms through which the malabsorption of key nutrients induced by bariatric surgery adversely affects bone. The current article, Part 2, reviews the specific changes seen in bone metabolism after bariatric surgery and the current data on the underlying mechanisms, in addition to nutrient malabsorption, that may contribute to bariatric surgery-induced bone loss. These mechanisms include mechanical unloading, calcium malabsorption despite maintenance of vitamin D levels of ≥30 ng/mL, and changes in a number of hormones, including leptin, adiponectin, testosterone, estradiol, serotonin, ghrelin, glucagon-like peptide 1 (GLP-1), and gastric inhibitory peptide (GIP). Research discussing the use of nutritional supplements to help ameliorate bariatric surgery-induced bone loss is summarized. The adverse effects of bariatric surgery on bone must be widely recognized, and protocols must be developed to prevent early onset osteoporosis in recipients of this increasingly utilized and otherwise potentially life-saving surgery.
如第1部分所讨论的，肥胖如今已成为一种全球性流行病，影响着大量且数量迅速增加的成年人、青少年和儿童。随着肥胖发病率的上升，用于治疗肥胖的减重手术的使用也在增加。越来越多最近发表的研究报告称，尽管补充了钙和维生素D，但最常施行的减重手术类型，即 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG），会导致显著且持续的骨质流失。最近对减重手术引起的营养吸收不良和多种激素变化的研究表明，钙吸收不良只是这座巨大冰山的一角。第1部分回顾了最新研究结果，证实肥胖的患病率实际上正在飙升，且减重手术会导致持续加速的骨质流失。第1部分还讨论了减重手术引起的关键营养素吸收不良对骨骼产生不利影响的机制。本文第2部分除了回顾营养吸收不良之外，还将审视减重手术后骨代谢中出现的具体变化以及关于可能导致减重手术引起骨质流失的潜在机制的现有数据。这些机制包括机械性失用、尽管维生素D水平维持在≥30 ng/mL 仍存在钙吸收不良，以及多种激素的变化，包括瘦素、脂联素、睾酮、雌二醇、血清素、胃饥饿素、胰高血糖素样肽1（GLP-1）和胃抑制肽（GIP）。文中总结了有关使用营养补充剂来帮助改善减重手术引起的骨质流失的研究。必须广泛认识到减重手术对骨骼的不良影响，并且必须制定方案以预防接受这种日益普及且在其他方面可能挽救生命的手术的患者过早发生骨质疏松。
