Department of Rheumatology, MABLaB ULR 4490, CHU Lille, Univ. Lille, 59000, Lille, France.
Department of Rheumatology, MABLaB ULR 4490, CHU Lille, 2, Avenue Oscar Lambret, 59037, Lille, France.
Calcif Tissue Int. 2022 May;110(5):576-591. doi: 10.1007/s00223-020-00798-w. Epub 2021 Jan 5.
It has been increasingly acknowledged that bariatric surgery adversely affects skeletal health. After bariatric surgery, the extent of high-turnover bone loss is much greater than what would be expected in the absence of a severe skeletal insult. Patients also experience a significant deterioration in bone microarchitecture and strength. There is now a growing body of evidence that suggests an association between bariatric surgery and higher fracture risk. Although the mechanisms underlying the high-turnover bone loss and increase in fracture risk after bariatric surgery are not fully understood, many factors seem to be involved. The usual suspects are nutritional factors and mechanical unloading, and the roles of gut hormones, adipokines, and bone marrow adiposity should be investigated further. Roux-en-Y gastric bypass (RYGB) was once the most commonly performed bariatric procedure worldwide, but sleeve gastrectomy (SG) has now become the predominant bariatric procedure. Accumulating evidence suggests that RYGB is associated with a greater reduction in BMD, a greater increase in markers of bone turnover, and a higher risk of fracture than SG. These findings should be taken into consideration in determining the most appropriate bariatric procedure for patients, especially those at higher fracture risk. Before and after all bariatric procedures, sufficient calcium, vitamin D and protein intake, and adequate physical activity, are needed to counteract negative impacts on bone. There are no studies to date that have evaluated the effect of osteoporosis treatment on high-turnover bone loss after bariatric surgery. However, in patients with a diagnosis of osteoporosis, anti-resorptive agents may be considered.
人们越来越认识到，减重手术会对骨骼健康产生不利影响。在减重手术后，高转换性骨丢失的程度远远超过没有严重骨骼损伤的情况下所预期的程度。患者的骨微结构和强度也会显著恶化。越来越多的证据表明，减重手术与更高的骨折风险之间存在关联。尽管减重手术后高转换性骨丢失和骨折风险增加的机制尚未完全清楚，但似乎涉及许多因素。常见的罪魁祸首是营养因素和机械性失负荷，而肠激素、脂肪因子和骨髓脂肪含量的作用应该进一步研究。Roux-en-Y 胃旁路术（RYGB）曾经是全球最常见的减重手术，但袖状胃切除术（SG）现在已成为主要的减重手术。越来越多的证据表明，RYGB 与骨密度降低幅度更大、骨转换标志物增加幅度更大以及骨折风险更高有关，而 SG 则与之相反。在为患者确定最合适的减重手术时，应考虑这些发现，尤其是那些骨折风险较高的患者。在所有减重手术之前和之后，都需要摄入足够的钙、维生素 D 和蛋白质，并进行足够的身体活动，以抵消对骨骼的负面影响。目前尚无研究评估骨质疏松症治疗对减重手术后高转换性骨丢失的影响。然而，对于诊断为骨质疏松症的患者，可能会考虑使用抗吸收药物。
