Gagnon Claudia, Schafer Anne L
Department of Medicine Université Laval Quebec City Canada.
Endocrinology and Nephrology Unit CHU de Quebec Research Centre Quebec City Canada.
JBMR Plus. 2018 May 1;2(3):121-133. doi: 10.1002/jbm4.10048. eCollection 2018 May.
Bariatric surgery results in long-term weight loss and improvement or resolution in obesity-related comorbidities. However, mounting evidence indicates that it adversely affects bone health. This review summarizes clinical research findings about the impact of bariatric surgery on skeletal outcomes. The literature is the largest and strongest for the Roux-en-Y gastric bypass (RYGB) procedure, as RYGB was the most commonly performed bariatric procedure worldwide until it was very recently overtaken by the sleeve gastrectomy (SG). Because SG is a newer procedure, its skeletal effects have not yet been well defined. Epidemiologic studies have now demonstrated an increased risk of fracture after RYGB and biliopancreatic diversion with duodenal switch, both of which include a malabsorptive component. As these epidemiologic data have emerged, patient-oriented studies have elucidated the bone tissue-level changes that may account for the heightened skeletal fragility. Bariatric surgery induces early and dramatic increases in biochemical markers of bone turnover. A notable feature of recent patient-oriented clinical studies is the application of advanced skeletal imaging modalities; studies address the limitations of dual-energy X-ray absorptiometry (DXA) by using quantitative computed tomography (QCT)-based modalities to examine volumetric bone mineral density and compartment-specific density and microstructure. RYGB results in pronounced declines in bone mass at the axial skeleton demonstrated by DXA and QCT, as well as at the appendicular skeleton demonstrated by high-resolution peripheral quantitative computed tomography (HR-pQCT). RYGB has detrimental effects on trabecular and cortical microarchitecture and estimated bone strength. Skeletal changes after RYGB appear early and continue even after weight loss plateaus and weight stabilizes. The skeletal effects of bariatric surgery are presumably multifactorial, and mechanisms may involve nutritional factors, mechanical unloading, hormonal factors, and changes in body composition and bone marrow fat. Clinical guidelines address bone health and may mitigate the negative skeletal effects of surgery, although more research is needed to direct and support such guidelines. © 2018 The Authors. is published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
减重手术可带来长期体重减轻，并改善或解决肥胖相关的合并症。然而，越来越多的证据表明，它会对骨骼健康产生不利影响。本综述总结了关于减重手术对骨骼结局影响的临床研究结果。就Roux-en-Y胃旁路术（RYGB）而言，相关文献数量最多且证据最充分，因为直到最近被袖状胃切除术（SG）超越之前，RYGB一直是全球最常用的减重手术。由于SG是一种较新的手术，其对骨骼的影响尚未得到明确界定。流行病学研究现已表明，RYGB和胆胰转流十二指肠转位术后骨折风险增加，这两种手术都包含吸收不良成分。随着这些流行病学数据的出现，以患者为导向的研究阐明了可能导致骨骼脆性增加的骨组织水平变化。减重手术会导致骨转换生化标志物早期急剧升高。近期以患者为导向的临床研究的一个显著特点是应用了先进的骨骼成像模式；这些研究通过使用基于定量计算机断层扫描（QCT）的模式来检查体积骨密度和特定部位的密度及微观结构，解决了双能X线吸收法（DXA）的局限性。DXA和QCT显示，RYGB会导致轴向骨骼骨量显著下降，高分辨率外周定量计算机断层扫描（HR-pQCT）显示，在附属骨骼也会出现这种情况。RYGB对小梁和皮质微结构以及估计的骨强度有不利影响。RYGB术后的骨骼变化出现得很早，即使体重减轻趋于平稳且体重稳定后仍会持续。减重手术对骨骼的影响可能是多因素的，其机制可能涉及营养因素、机械卸载、激素因素以及身体成分和骨髓脂肪的变化。临床指南涉及骨骼健康，可能会减轻手术对骨骼的负面影响，不过还需要更多研究来指导和支持此类指南。© 2018作者。由Wiley Periodicals, Inc.代表美国骨与矿物质研究学会出版。
