Department of Surgery, Duke University Medical Center, 407 Crutchfield St, Durham, NC, 27704, USA.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA.
Surg Endosc. 2020 Apr;34(4):1754-1760. doi: 10.1007/s00464-019-06922-8. Epub 2019 Jun 17.
Accelerated bone loss is a known complication after bariatric surgery. Bone mineral density has been shown to decrease significantly after Laparoscopic Roux-en-Y gastric bypass (RYGB). Laparoscopic sleeve gastrectomy (SG) effects on bone density are largely unknown. This should be considered for those with increased preoperative risk for bone loss, such as postmenopausal females.
This prospective clinical trial included postmenopausal patients, with BMI ≥ 35 k/m, being evaluated for either RYGB or SG. Patients with history of osteoporosis, estrogen hormone replacement therapy, active smoking, glucocorticoid use, or weight > 295 lb were excluded. Patients underwent DEXA scans preoperatively and 1 year postoperatively with measurement of total body bone mineral density (BMD) and bone mineral content (BMC) as well as regional site-specific BMD and BMC.
A total of 28 patients were enrolled. 16 (57.1%) patients underwent RYGB and 12 (42.9%) patients underwent SG. Median preoperative BMI was 44.2 k/m (IQR 39.9, 46.6). Median change in BMI at 12 months was - 11.3 k/m (IQR - 12.8, - 7.9). A significant reduction in total body BMC was seen when comparing preoperative measurements to postoperative measurements (2358.32 vs 2280.68 grams; p = 0.002). Regional site BMC and BMD significantly decreased in the ribs and spine postoperatively (p = < 0.02) representing the greatest loss in the axial skeleton. Comparing those who underwent RYGB to SG there was no significant difference between the two groups when evaluating changes in total or regional site BMD.
Postmenopausal women were found to have decreased BMD and BMC after RYGB and SG, suggesting that high-risk women may benefit from postoperative DEXA screening. Further study is needed to determine the clinical significance of these findings. It is unknown if these changes in BMD are due to modifiable factors (Vitamin D level, activity level, hormone status, etc.), and whether BMD and BMC is recovered beyond 1 year.
减重手术后加速的骨质流失是一种已知的并发症。腹腔镜 Roux-en-Y 胃旁路术（RYGB）后骨密度会显著下降。腹腔镜袖状胃切除术（SG）对骨密度的影响在很大程度上尚不清楚。对于术前骨质流失风险增加的患者，如绝经后女性，应考虑这一点。
这项前瞻性临床试验纳入了绝经后 BMI≥35 kg/m2 的患者，评估接受 RYGB 或 SG。有骨质疏松史、雌激素激素替代治疗、主动吸烟、糖皮质激素使用或体重>295 磅的患者被排除在外。患者术前和术后 1 年均接受 DEXA 扫描，测量全身骨矿物质密度（BMD）和骨矿物质含量（BMC）以及特定区域的 BMD 和 BMC。
共纳入 28 例患者，其中 16 例（57.1%）患者接受 RYGB，12 例（42.9%）患者接受 SG。术前 BMI 中位数为 44.2 kg/m2（IQR 39.9, 46.6）。12 个月时 BMI 中位数下降 11.3 kg/m2（IQR -12.8, -7.9）。与术前相比，术后全身 BMC 显著减少（2358.32 与 2280.68 克；p=0.002）。术后肋骨和脊柱的局部骨 BMC 和 BMD 显著下降（p<0.02），代表轴向骨骼的最大丢失。比较 RYGB 和 SG 两组，两组间总或局部部位 BMD 的变化无显著差异。
RYGB 和 SG 后绝经后妇女的 BMD 和 BMC 降低，提示高危女性可能受益于术后 DEXA 筛查。需要进一步研究以确定这些发现的临床意义。尚不清楚这些 BMD 变化是否是由于可改变的因素（维生素 D 水平、活动水平、激素状态等）引起的，以及 BMD 和 BMC 是否在 1 年后恢复。
