Kalani A, Bami H, Tiboni M, Jaeschke R, Adachi J D, Lau A N
Department of Internal Medicine McMaster University Hamilton ON Canada.
Schulich School of Medicine and Dentistry Western University London ON Canada.
Obes Sci Pract. 2017 Jun 27;3(3):319-332. doi: 10.1002/osp4.113. eCollection 2017 Sep.
Concerns have emerged about post-operative decreases in calcium and vitamin D following bariatric surgery. This review explores changes in metabolic bone health in persons with obesity undergoing gastric bypass surgery compared to non-surgical controls, providing an updated and comprehensive perspective on the literature.
An electronic search was conducted in MEDLINE, Pubmed, EMBASE and Cochrane databases to 8 November 2016. Eligible trials included randomized controlled trials or controlled observational studies of patients who have undergone laparoscopic gastric bypass surgery. Statistical analysis was carried out using the Cochrane Collaboration Review Manager (RevMan 5.0), and a random effects model was implemented. Outcomes were expressed as weighted mean difference (WMD). The primary outcome examined was change in 25-OH-D levels at 12 months post surgery, and secondary outcomes included change in bone mineral density (BMD) measurements at 12 months post surgery at the lumbar spine (LS) and total hip (TH).
At 12 months, there was no significant difference in 25-OH vitamin D in the surgical group compared to controls (WMD = 6.79%; 95% CI: -9.01, 22.59; = 0.40; I = 68%). There was no statistically significant difference between fracture risk in the surgical population compared to controls (RR = 1.24; 95% CI: 0.99, 1.56; = 0.06; I = 0%). A significant BMD reduction was however shown at the TH (WMD, -7.33%, 95% CI = -8.70 to -5.97, < .001, I = 0%), and a trend towards decline was observed at the LS (WMD, -1.73%, 95% CI = -3.56 to 0.11, = 0.06, I = 0%). Changes at 24 months for applicable outcomes were similar to the results at 12 months.
Bariatric surgery may compromise metabolic bone health, but the paucity of high-quality literature limits conclusions.
肥胖症手术后钙和维生素D水平下降的问题已引起关注。本综述探讨了接受胃旁路手术的肥胖患者与非手术对照组相比代谢性骨健康的变化，为相关文献提供了更新且全面的观点。
截至2016年11月8日，在MEDLINE、PubMed、EMBASE和Cochrane数据库中进行了电子检索。符合条件的试验包括接受腹腔镜胃旁路手术患者的随机对照试验或对照观察性研究。使用Cochrane协作网综述管理器（RevMan 5.0）进行统计分析，并采用随机效应模型。结果以加权平均差（WMD）表示。主要观察结果是术后12个月时25-羟维生素D水平的变化，次要观察结果包括术后12个月时腰椎（LS）和全髋（TH）骨密度（BMD）测量值的变化。
术后12个月时，手术组与对照组相比，25-羟维生素D无显著差异（WMD = 6.79%；95%置信区间：-9.01，22.59；P = 0.40；I² = 68%）。手术人群与对照组相比，骨折风险无统计学显著差异（RR = 1.24；95%置信区间：0.99，1.56；P = 0.06；I² = 0%）。然而，全髋处显示出显著的骨密度降低（WMD，-7.33%，95%置信区间 = -8.70至-5.97，P <.001，I² = 0%），腰椎处观察到有下降趋势（WMD，-1.73%，95%置信区间 = -3.56至0.11，P = 0.06，I² = 0%）。适用结果在24个月时的变化与12个月时的结果相似。
减肥手术可能会损害代谢性骨健康，但高质量文献的匮乏限制了结论的得出。
