Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, Massachusetts.
Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):326-336. doi: 10.1210/clinem/dgaa836.
The prevalence of childhood obesity has increased over past decades with a concomitant increase in metabolic and bariatric surgery (MBS). While MBS in adults is associated with bone loss, only a few studies have examined the effect of MBS on the growing skeleton in adolescents.
This mini-review summarizes available data on the effects of the most commonly performed MBS (sleeve gastrectomy and gastric bypass) on bone in adolescents. A literature review was performed using PubMed for English-language articles.
Dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density (aBMD) and BMD Z scores decreased following all MBS. Volumetric BMD (vBMD) by quantitative computed tomography (QCT) decreased at the lumbar spine while cortical vBMD of the distal radius and tibia increased over a year following sleeve gastrectomy (total vBMD did not change). Reductions in narrow neck and intertrochanteric cross-sectional area and cortical thickness were observed over this duration, and hip strength estimates were deleteriously impacted. Marrow adipose tissue (MAT) of the lumbar spine increased while MAT of the peripheral skeleton decreased a year following sleeve gastrectomy. The amount of weight loss and reductions in lean and fat mass correlated with bone loss at all sites, and with changes in bone microarchitecture at peripheral sites.
MBS in adolescents is associated with aBMD reductions, and increases in MAT of the axial skeleton, while sleeve gastrectomy is associated with an increase in cortical vBMD and decrease in MAT of the peripheral skeleton. No reductions have been reported in peripheral strength estimates.
在过去几十年中，儿童肥胖症的患病率不断增加，随之而来的是代谢和减重手术（MBS）的增加。虽然成年人的 MBS 与骨丢失有关，但只有少数研究检查了 MBS 对青少年生长骨骼的影响。
本迷你综述总结了最常进行的 MBS（胃袖状切除术和胃旁路术）对青少年骨骼影响的现有数据。使用 PubMed 对英文文章进行了文献回顾。
双能 X 射线吸收法（DXA）测量的面积骨密度（aBMD）和 BMD Z 评分在所有 MBS 后均降低。定量计算机断层扫描（QCT）的体积骨密度（vBMD）在腰椎下降，而桡骨远端和胫骨的皮质 vBMD 在胃袖状切除术后一年增加（总 vBMD 没有变化）。在此期间观察到狭窄颈部和转子间区域的横截面积和皮质厚度减少，并且髋部力量估计值受到不利影响。腰椎的骨髓脂肪组织（MAT）增加，而胃袖状切除术后一年外周骨骼的 MAT 减少。所有部位的体重减轻和瘦体重和脂肪量的减少与骨丢失相关，并且与外周部位的骨微结构变化相关。
青少年的 MBS 与 aBMD 降低以及轴向骨骼的 MAT 增加有关，而胃袖状切除术与外周骨骼的 MAT 增加和皮质 vBMD 降低有关。在周围强度估计中没有报告减少。
