Endocrinology, Diabetology & Nutrition Department, University Hospital of Bordeaux, Pessac, France.
University of Bordeaux, College Santé, 33076, Bordeaux, France.
Obes Surg. 2020 Sep;30(9):3317-3325. doi: 10.1007/s11695-020-04568-3.
Bone mineral density (BMD) declines in the initial years after bariatric surgery, but long-term skeletal effects are unclear and comparisons between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are rare.
An observational longitudinal study of obese patients undergoing SG or RYGB was performed. Whole-body (WB) BMD, along with BMD of the total hip (TH), femoral neck (FN), and lumbar spine (LS), was measured by dual-energy X-ray absorptiometry (DXA) before surgery and yearly thereafter for 4 years. Calciotropic hormones were also measured.
Forty-seven patients undergoing RYGB surgery and 28 patients undergoing SG were included. Four years after RYGB, BMD declined by 2.8 ± 5.8% in LS, 8.6 ± 5% in FN, 10.9 ± 6.3% in TH, and 4.2 ± 6.2% in WB, relative to baseline. For SG, BMD declined by 8.1 ± 5.5% in FN, 7.7 ± 6% in TH, 2.0 ± 7.2% in LS, and 2.5 ± 6.4% in WB after 4 years, relative to baseline. Vitamin D levels increased with supplementation in both groups. Whereas parathyroid hormone levels increased slightly in the RYGB group, they decreased modestly in the SG group (P < 0.05 in both groups).
Bone loss after 4 years was comparable between the two procedures, although RYGB was associated with a slightly greater decrease at the TH than SG. Bone health should therefore be monitored after both RYGB and SG.
减重手术后最初几年骨密度（BMD）会下降，但长期骨骼影响尚不清楚，且 sleeve gastrectomy（SG）与 Roux-en-Y gastric bypass（RYGB）之间的比较很少。
对接受 SG 或 RYGB 的肥胖患者进行了一项观察性纵向研究。手术前和术后每年通过双能 X 射线吸收法（DXA）测量全身（WB）BMD 以及总髋部（TH）、股骨颈（FN）和腰椎（LS）的 BMD。还测量了钙调节激素。
纳入了 47 例行 RYGB 手术的患者和 28 例行 SG 的患者。RYGB 术后 4 年，LS 的 BMD 下降了 2.8±5.8%，FN 的 BMD 下降了 8.6±5.0%，TH 的 BMD 下降了 10.9±6.3%，WB 的 BMD 下降了 4.2±6.2%，与基线相比。SG 术后 4 年，FN 的 BMD 下降了 8.1±5.5%，TH 的 BMD 下降了 7.7±6.0%，LS 的 BMD 下降了 2.0±7.2%，WB 的 BMD 下降了 2.5±6.4%，与基线相比。两组患者的维生素 D 水平均随补充而增加。RYGB 组甲状旁腺激素水平略有升高，而 SG 组则略有下降（两组均 P<0.05）。
两种手术 4 年后的骨丢失相当，但 RYGB 与 SG 相比，TH 的下降幅度略大。因此，RYGB 和 SG 后都应监测骨骼健康。
