Department of Medical Education, Taichung Veterans General Hospital, Taichung.
Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital.
Medicine (Baltimore). 2021 May 21;100(20):e26061. doi: 10.1097/MD.0000000000026061.
The aim of this study is to evaluate the alterations in bone mineral density and other surrogate markers for osteoporosis in obese patients with type 2 diabetes mellitus (T2DM) who received Roux-en-Y gastric bypass (RYGB) versus medical treatment as control.
We searched 4 electronic databases and reference lists of relevant studies for eligible research published before December, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including lumbar spine bone mineral density (L-spine BMD) change, total hip BMD change, osteocalcin level, C-terminal telopeptide level, and parathyroid hormone level.
Three randomized clinical trials and 2 observational studies concerning 307 total obese T2DM patients were included. Follow-up ranged from 12 to 60 months. Patients underwent RYGB surgery were associated with both higher L-spine BMD loss (mean difference: -2.90, 95% CI: -2.99∼-2.81, P < .00001) and total hip BMD loss (mean difference: -5.81, 95% CI: -9.22∼-2.40, P = .0008). As to biochemical markers of bone metabolism, we found significantly higher osteocalcin level in medical treatment (control) group compared with RYGB group (mean difference: 11.16, 95% CI: 8.57-13.75, P < .00001). However, higher C-terminal telopeptide level and parathyroid hormone level were noted in medical treatment group (control) compared with RYGB group (mean difference: 0.29, 95% CI: 0.11-0.48, P = .002; mean difference: 1.56, 95% CI: 0.84-2.27, P < .0001).
RYGB surgery is associated with negative impact on bone metabolism and increase the risk of osteoporosis in obese patients with T2DM. We suggest that clinicians acknowledge the adverse effects of surgery and keep monitoring bone mineral components in post-RYGB populations. Further studies regarding the optimal amount of perioperative and postsurgical supplementation should be evaluated.
本研究旨在评估接受 Roux-en-Y 胃旁路术（RYGB）与作为对照的药物治疗的肥胖 2 型糖尿病（T2DM）患者的骨密度和其他骨质疏松替代标志物的变化。
我们搜索了 4 个电子数据库和相关研究的参考文献列表，以获取截至 2019 年 12 月发表的合格研究。经过质量评估，对合格研究进行了综合分析，以评估相关结局，包括腰椎骨密度（L 腰椎 BMD）变化、全髋 BMD 变化、骨钙素水平、C 端肽水平和甲状旁腺激素水平。
纳入了 307 名肥胖 T2DM 患者的 3 项随机临床试验和 2 项观察性研究。随访时间从 12 个月到 60 个月不等。接受 RYGB 手术的患者 L 腰椎 BMD 丢失（平均差值：-2.90，95%CI：-2.99∼-2.81，P<0.00001）和全髋 BMD 丢失（平均差值：-5.81，95%CI：-9.22∼-2.40，P=0.0008）更明显。至于骨代谢的生化标志物，我们发现药物治疗（对照组）组的骨钙素水平明显高于 RYGB 组（平均差值：11.16，95%CI：8.57-13.75，P<0.00001）。然而，药物治疗（对照组）组的 C 端肽水平和甲状旁腺激素水平更高（平均差值：0.29，95%CI：0.11-0.48，P=0.002；平均差值：1.56，95%CI：0.84-2.27，P<0.0001）。
RYGB 手术与肥胖 T2DM 患者的骨代谢不良影响有关，并增加骨质疏松的风险。我们建议临床医生认识到手术的不利影响，并在 RYGB 术后人群中持续监测骨矿物质成分。应该评估关于围手术期和术后最佳补充量的进一步研究。
