Department of Surgery, Rush University Medical Center, 1750 W Harrison St, 791 Jelke, Chicago, IL, 60612, USA.
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Obes Surg. 2020 Jan;30(1):290-295. doi: 10.1007/s11695-019-04154-2.
Roux-en-Y gastric bypass (RYGB) is a well-established treatment for morbid obesity and type 2 diabetes. The effects of RYGB on bone metabolism and bone health are largely unknown.
Determine the changes in osteoclast function and bone density 1 year after RYGB as compared with a control group undergoing a diabetes support and education program (DSE).
A prospective cohort study with patients matched for weight and age assigned to RYGB or DSE.
Large academic institution.
Patients with type 2 diabetes mellitus and morbid obesity (body mass index greater than 35 kg/m).
Subjects either received laparoscopic RYBG or DSE, which consisted of nutritional, exercise, and dietary counseling performed by a certified diabetic educator and a nutritionist three times over a year.
Osteoclast activity, bone mineral density.
One year after, intervention subjects undergoing RYGB have a 280% increase in osteoclast activity as compared with a 7.6% increase in the DSE control group (P < 0.001). Furthermore, there was a statistically significant increase in sclerostin levels in subjects undergoing RYGB compared with an increase in the control group. The total bone mineral density was statistically unchanged within 1 year of intervention in both groups. A statistically significant decrease in bone mineral density in the left ribs (decrease of 6.8%, P < 0.05) and lumbar spine (decrease of 4.0%, P < 0.05) was seen 1 year after RYGB.
There is a significant increase in osteoclast activity observed 1 year after RYGB; the long-term clinical implications of this increased bone metabolism are unknown.
Roux-en-Y 胃旁路术（RYGB）是治疗病态肥胖和 2 型糖尿病的成熟方法。RYGB 对骨代谢和骨骼健康的影响在很大程度上尚不清楚。
与接受糖尿病支持和教育计划（DSE）的对照组相比，确定 RYGB 后 1 年破骨细胞功能和骨密度的变化。
一项前瞻性队列研究，对体重和年龄匹配的患者进行分组，分别接受 RYGB 或 DSE 治疗。
大型学术机构。
患有 2 型糖尿病和病态肥胖（体重指数大于 35kg/m²）的患者。
研究对象接受腹腔镜 RYBG 或 DSE，其中包括由认证糖尿病教育者和营养师在一年中进行三次营养、运动和饮食咨询。
破骨细胞活性、骨矿物质密度。
干预 1 年后，接受 RYGB 的干预组破骨细胞活性增加了 280%，而 DSE 对照组仅增加了 7.6%（P<0.001）。此外，与对照组相比，接受 RYGB 的患者的 Sclerostin 水平有统计学显著增加。在干预后 1 年内，两组的总骨矿物质密度均无统计学变化。接受 RYGB 后 1 年，左侧肋骨（减少 6.8%，P<0.05）和腰椎（减少 4.0%，P<0.05）的骨矿物质密度出现统计学显著下降。
RYGB 后 1 年观察到破骨细胞活性显著增加；这种增加的骨代谢的长期临床意义尚不清楚。
