补充足够的维生素 D 并不能改善病态肥胖女性行长段肠-胆胰分流术后的骨丢失。

Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women.

机构信息

Division of Endocrinology, Department of Internal Medicine, School of Medicine, University of Patras, 26504, Rio, Greece.

Department of Radiology, School of Medicine, University of Patras, 26504, Rio, Greece.

出版信息

Hormones (Athens). 2021 Jun;20(2):315-321. doi: 10.1007/s42000-020-00254-2. Epub 2020 Nov 5.

DOI:10.1007/s42000-020-00254-2

PMID:33155141

Abstract

OBJECTIVES

The objective of this study is to investigate the effect of adequate vitamin D supplementation on bone mineral density (BMD) following long limb-biliopancreatic diversion (LL-BPD), a malabsorptive bariatric operation.

BACKGROUND

Marked weight loss following bariatric surgery is associated with significant decrease in BMD, attributed to the weight loss and to nutritional, mineral, and vitamin D deficiencies resulting in secondary hyperparathyroidism.

METHODS

Two groups, of 35 and 37 healthy, obese (BMI, 50.4 + 6.6 and 46.5 + 4.8 g/cm), premenopausal, normally menstruating women underwent LL-BPD. Both groups received high-calcium diets, 600 IU of vitamin D, and 1000 mg elemental calcium daily, while group B received an extra dose of vitamin D (10,000 IU/day) during the first postoperative month, followed by dose adjustment in order to maintain 25OHD concentration higher than 30 μg/L. Areal BMD (aBMD) was measured at the lumbar spine preoperatively and 1 year postoperatively.

RESULTS

One year postoperatively, BMI decreased by approximately 19 kg/m in both groups, while 25-OH-vitamin D levels did not change in group A (18.7 + 9.1 to 20.2 + 13.0 μg/L, (p = 0.57)) and increased in group B (15.58 ± 5.73 to 52.97 ± 15.46 μg/L, (p = < 0.001). PTH levels increased in group A (from 38.5 ± 12.2 to 51.2 ± 32.8 pg/ml) (p = 0.047) and decreased in group B (from 51.61 ± 18.7 to 45.1 ± 17.8 pg/ml) (p = 0.042). Lumbar spine aBMD decreased similarly in both groups (p = 0.311, for the comparison between groups) from 1.198 + 0.14 to 1.103 + 0.15 g/cm in group A (p < 0.001) and from 1.157 + 0.14 to 1.076 + 0.14 g/cm in group B (p < 0.001) and Z-score from 0.93 + 0.97 to 0.19 + 1.02, (p < 0.001) and from 1.15 + 1.29 to 0.419 + 1.28, (p < 0.001), respectively.

CONCLUSIONS

LL-BPD leads to similar and significant bone mass reduction 1 year postoperatively, irrespective of adequate vitamin D replacement and in the absence of secondary hyperparathyroidism.

摘要

目的

本研究旨在探讨充分的维生素 D 补充对长肢胆胰分流术（LL-BPD）后骨密度（BMD）的影响，LL-BPD 是一种吸收不良的减肥手术。

背景

减肥手术后显著的体重减轻与 BMD 显著下降有关，这归因于体重减轻以及导致继发性甲状旁腺功能亢进的营养、矿物质和维生素 D 缺乏。

方法

35 名和 37 名健康肥胖（BMI，50.4±6.6 和 46.5±4.8g/cm）、绝经前、月经正常的女性接受 LL-BPD。两组均接受高钙饮食、600IU 维生素 D 和每天 1000mg 元素钙，而 B 组在术后第一个月额外服用维生素 D（10000IU/天），然后调整剂量以维持 25-OHD 浓度高于 30μg/L。术前和术后 1 年测量腰椎的面积 BMD（aBMD）。

结果

两组术后 1 年 BMI 分别下降约 19kg/m2，而 A 组 25-OH-维生素 D 水平无变化（18.7±9.1 至 20.2±13.0μg/L，（p=0.57）），B 组增加（15.58±5.73 至 52.97±15.46μg/L，（p<0.001）。A 组甲状旁腺素水平升高（从 38.5±12.2 至 51.2±32.8pg/ml）（p=0.047），B 组降低（从 51.61±18.7 至 45.1±17.8pg/ml）（p=0.042）。两组腰椎 aBMD 均有类似下降（p=0.311，组间比较），A 组从 1.198±0.14 降至 1.103±0.15g/cm（p<0.001），B 组从 1.157±0.14 降至 1.076±0.14g/cm（p<0.001），Z 评分从 0.93±0.97 降至 0.19±1.02（p<0.001），从 1.15±1.29 降至 0.419±1.28（p<0.001）。