Department of Radiology, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
Neuroendocrine Unit, Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
Bone. 2021 Aug;149:115975. doi: 10.1016/j.bone.2021.115975. Epub 2021 Apr 24.
Sleeve gastrectomy (SG) is the most common metabolic and bariatric surgery (MBS) procedure in adolescents and adults. Only few studies have assessed bone outcomes following SG and it is unknown whether skeletal changes differ by age group. Recent studies have identified marrow adipose tissue (MAT) as a novel biomarker for bone quality with studies in adults showing high MAT in those with visceral adiposity and a reciprocal increase in MAT with bone loss.
To determine the impact of SG on volumetric BMD (vBMD) and MAT in adolescents and adults with obesity. We hypothesized that SG would lead to a decrease in vBMD and increase in MAT but that these changes would be less pronounced in adolescents compared to adults.
The study was IRB-approved and HIPAA-compliant. Written informed consent/assent was obtained. We examined 10 adolescents (mean age 17.8 ± 2.5 years, mean BMI 43.5 ± 5.6 kg/m) and 10 sex, race, and BMI-matched adults (mean age 49.5 ± 13.6 years, mean BMI 43.7 ± 5.9 kg/m), before and 12 months after SG. At baseline and 12 months, subjects underwent quantitative CT of the lumbar spine (L1-L2) to assess trabecular vBMD, single voxel proton MR spectroscopy at 3 T (PRESS pulse sequence without water suppression) at L1-L2 to quantify MAT, and MRI of the abdomen to assess visceral (VAT) and subcutaneous adipose tissue (SAT).
At baseline, adolescents had lower MAT (p = 0.0002) and higher vBMD (p = 0.050) compared to adults. Adolescents and adults lost 27.9 ± 6.5 vs. 25.0 ± 11.2% of body weight (p < 0.0001 for within group change), while there was no significant difference between groups (p = 0.455). There was a significant reduction in vBMD in adults (-3.9 ± 3.9%, p = 0.005) and a trend for a reduction in adolescents (-3.7 ± 7.5%, p = 0.119), with no significant difference between groups (p = 0.944). Lumbar MAT content increased in both adults and adolescents (p ≤ 0.034), while the difference was not significant between groups (p = 0.281). In adolescents and adults, 12-month percent change in weight and BMI was positively associated with % change in MAT (p ≤ 0.042). 12-month percent change in MAT was positively associated with 12-month % change in SAT in adolescents and 12-month percent change in VAT in adults (p ≤ 0.045).
SG in adolescents and adults with severe obesity is associated with a reduction in lumbar vBMD and an increase in lumbar MAT, although the reduction in adolescents did not reach statistical significance, with no significant differences in these endpoints between groups. Our results suggest detrimental effects of bariatric surgery on bone for patients across the life span.
袖状胃切除术（SG）是青少年和成年人中最常见的代谢和减重手术（MBS）程序。只有少数研究评估了 SG 后的骨骼结果，并且尚不清楚骨骼变化是否因年龄组而异。最近的研究已经确定骨髓脂肪组织（MAT）是骨质量的一种新的生物标志物，研究表明内脏肥胖者的 MAT 较高，而随着骨量丢失，MAT 呈反式增加。
确定 SG 对肥胖青少年和成年人的体积骨密度（vBMD）和 MAT 的影响。我们假设 SG 会导致 vBMD 降低和 MAT 增加，但与成年人相比，这些变化在青少年中不太明显。
该研究获得了机构审查委员会的批准和 HIPAA 合规性。获得了书面知情同意/同意。我们在 SG 前后检查了 10 名青少年（平均年龄 17.8±2.5 岁，平均 BMI 43.5±5.6 kg/m）和 10 名性别、种族和 BMI 匹配的成年人（平均年龄 49.5±13.6 岁，平均 BMI 43.7±5.9 kg/m）。在基线和 12 个月时，受试者接受了腰椎（L1-L2）的定量 CT 以评估小梁 vBMD，在 3T 上进行了单像素质子磁共振波谱（不进行水抑制的 PRESS 脉冲序列），以量化 MAT，以及腹部 MRI 以评估内脏（VAT）和皮下脂肪组织（SAT）。
在基线时，青少年的 MAT 较低（p=0.0002），vBMD 较高（p=0.050）。青少年和成年人分别失去了 27.9±6.5%和 25.0±11.2%的体重（p<0.0001，组内变化），但两组之间无显著差异（p=0.455）。成年人的 vBMD 显著降低（-3.9±3.9%，p=0.005），青少年有降低的趋势（-3.7±7.5%，p=0.119），两组之间无显著差异（p=0.944）。成年人和青少年的腰椎 MAT 含量均增加（p≤0.034），但两组之间无显著差异（p=0.281）。青少年和成年人中，体重和 BMI 的 12 个月百分比变化与 MAT 的百分比变化呈正相关（p≤0.042）。青少年中 12 个月 MAT 百分比变化与 12 个月 SAT 百分比变化呈正相关，成年人中 12 个月 VAT 百分比变化与 12 个月 MAT 百分比变化呈正相关（p≤0.045）。
严重肥胖的青少年和成年人的 SG 与腰椎 vBMD 降低和腰椎 MAT 增加有关，尽管青少年的降低未达到统计学意义，两组之间这些终点无显著差异。我们的研究结果表明，减重手术对患者整个生命周期的骨骼都有不利影响。
