Applied Physiology & Nutrition Research Group, Laboratory of Assessment and Conditioning in Rheumatology, School of Physical Education and Sport, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil.
Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil.
J Clin Endocrinol Metab. 2019 Oct 1;104(10):4639-4650. doi: 10.1210/jc.2019-00074.
Bone loss after bariatric surgery potentially could be mitigated by exercise.
To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss.
Randomized, controlled trial.
Referral center for bariatric surgery.
Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB).
Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only).
Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes.
Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium).
Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.
减重手术后的骨丢失可能可以通过运动来减轻。
研究运动训练（ET）在减轻减重手术引起的骨丢失中的作用。
随机对照试验。
减重手术转诊中心。
70 名年龄在 25 至 55 岁之间的严重肥胖女性，接受 Roux-en-Y 胃旁路术（RYGB）。
RYGB 后接受 6 个月的监督 ET 方案与标准护理（仅 RYGB）。
手术显著降低了股骨颈、全髋、桡骨远端和全身 aBMD（P < 0.001）；并增加了骨转换标志物，包括 I 型胶原 C 端肽（CTX）、I 型前胶原 N 端肽（P1NP）、骨硬化蛋白和骨桥蛋白（P < 0.05）。与仅 RYGB 相比，运动减轻了股骨颈[估计平均差异（EMD），-2.91%；P = 0.007；]、全髋（EMD，-2.26%；P = 0.009）、桡骨远端（EMD，-1.87%；P = 0.038）和桡骨远端皮质体积骨密度（EMD，-2.09%；P = 0.024）的 aBMD 损失百分比。运动还降低了 CTX（EMD，-0.20ng/ml；P = 0.002）、P1NP（EMD，-17.59ng/ml；P = 0.024）和骨硬化蛋白水平（EMD，-610pg/ml；P = 0.046）与 RYGB 相比。运动不影响生化标志物（例如，25（OH）D、钙、完整 PTH、磷和镁）。
运动减轻了减重手术引起的骨丢失，可能通过抑制骨转换和骨硬化蛋白来实现。术后应将运动纳入护理，以保持骨量。
