胃旁路术后肥胖女性骨小梁骨评分在骨微结构评估中的价值
Is Trabecular Bone Score Valuable in Bone Microstructure Assessment after Gastric Bypass in Women with Morbid Obesity?
机构信息
Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge-IDIBELL, c/ FeixaLlarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Clinical Nutrition Unit, Hospital Universitari de Bellvitge-IDIBELL, c/ FeixaLlarga s/n, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
出版信息
Nutrients. 2017 Dec 2;9(12):1314. doi: 10.3390/nu9121314.
INTRODUCTION
The effects of bariatric surgery on skeletal health raise many concerns. Trabecular bone score (TBS) is obtained through the analysis of lumbar spine dual X-ray absorptiometry (DXA) images and allows an indirect assessment of skeletal microarchitecture (MA). The aim of our study was to evaluate the changes in bone mineral density (BMD) and alterations in bone microarchitecture assessed by TBS in morbidly obese women undergoing Roux-en-Y gastric bypass (RYGB), over a three-year follow-up.
MATERIAL/METHODS: A prospective study of 38 morbidly obese white women, aged 46.3 ± 8.2 years, undergoing RYGB was conducted. Biochemical analyses and DXA scans with TBS evaluation were performed before and at one year and three years after surgery.
RESULTS
Patients showed normal calcium and phosphorus plasma concentrations throughout the study. However, 25-hydroxyvitamin D (25(OH)D₃) decreased, and 71% of patients had a vitamin D deficiency at three years. BMD at femoral neck and lumbar spine (LSBMD) significantly decreased 13.53 ± 5.42% and 6.03 ± 6.79%, respectively, during the three-year follow-up; however -score values remained above those for women of the same age. TBS was within normal ranges at one and three years (1.431 ± 106 and 1.413 ± 85, respectively), and at the end of the study, 73.7% of patients had normal bone MA. TBS at three years correlated inversely with age ( = -0.41, = 0.010), body fat ( = -0.465, = 0.004) and greater body fat deposited in trunk ( = -0.48, = 0.004), and positively with LSBMD ( = 0.433, = 0.007), fat mass loss ( = 0.438, = 0.007) and lean mass loss ( = 0.432, = 0.008). In the regression analysis, TBS remained associated with body fat ( = -0.625, = 0.031; ² = 0.47). The fracture risk, calculated by FRAX (University of Sheffield, Sheffield, UK), with and without adjustment by TBS, was low.
CONCLUSION
Women undergoing RYGB in the mid-term have a preserved bone MA, assessed by TBS.
简介
减重手术对骨骼健康的影响引发了诸多关注。通过腰椎双能 X 射线吸收法（DXA）图像分析得出的骨小梁评分（TBS），可间接评估骨骼微结构（MA）。本研究旨在评估 38 名病态肥胖女性在接受 Roux-en-Y 胃旁路术（RYGB）后三年内骨密度（BMD）的变化和 TBS 评估的骨微结构改变。
材料/方法：对 38 名年龄为 46.3 ± 8.2 岁的白人病态肥胖女性进行前瞻性研究，进行 RYGB 手术。在手术前和手术后一年和三年进行生化分析和 TBS 评估 DXA 扫描。
结果
研究期间，患者的血浆钙和磷浓度正常。然而，25-羟维生素 D（25（OH）D₃）减少，71%的患者在三年内维生素 D 缺乏。在三年的随访中，股骨颈和腰椎骨密度（LSBMD）分别显著下降 13.53 ± 5.42%和 6.03 ± 6.79%；然而，-评分值仍高于同年龄女性。TBS 在术后一年和三年分别处于正常范围（1.431 ± 106 和 1.413 ± 85），研究结束时，73.7%的患者骨 MA 正常。TBS 在三年内与年龄呈负相关（r = -0.41，p = 0.010），与体脂（r = -0.465，p = 0.004）和躯干体脂含量增加（r = -0.48，p = 0.004）呈负相关，与 LSBMD 呈正相关（r = 0.433，p = 0.007），与脂肪质量损失（r = 0.438，p = 0.007）和瘦体重损失（r = 0.432，p = 0.008）呈正相关。在回归分析中，TBS 仍与体脂呈负相关（β = -0.625，p = 0.031；² = 0.47）。通过英国谢菲尔德大学的 FRAX（骨折风险评估工具）计算的骨折风险（不论是否通过 TBS 调整）均较低。
结论
接受 RYGB 的女性在中期仍具有由 TBS 评估的保存的骨 MA。
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