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胃旁路手术后骨密度和骨代谢的长期变化:一项回顾性队列研究。

Long-Term Changes in Bone Density and Bone Metabolism After Gastric Bypass Surgery: a Retrospective Cohort Study.

机构信息

Post-Graduate Program in Medical Sciences - Endocrinology (PPG ENDO), Universidade Federal do Rio Grande do Sul, (UFRGS), Porto Alegre, Brazil.

Statistics Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.

出版信息

Obes Surg. 2023 Mar;33(3):911-919. doi: 10.1007/s11695-022-06448-4. Epub 2023 Jan 7.

Abstract

PURPOSE

Patients with severe obesity submitted to Roux-en-Y gastric bypass (RYGB) are at risk of developing long-term hypovitaminosis D and secondary hyperparathyroidism (SHPT) as well as osteometabolic disease. This study aimed to evaluate calcium-vitamin D-PTH axis and bone mineral density (BMD) changes from post-RYGB patients who were followed-up until a median of 5 years.

MATERIALS AND METHODS

Vitamin D deficiency was defined as 25-hydroxyvitamin D <20 ng/mL and SHPT as PTH >68 pg/mL, in patients with normal serum creatinine and calcium. BMD was estimated by dual-energy X-ray absorptiometry (DXA, g/cm).

RESULTS

We included 127 post-RYGB patients (51±10.6 years, 87.4% self-declared White, 91.3% female, 52.8% postmenopausal). Vitamin D deficiency prevalence was the highest (41.5%) in the second year and the lowest (21.2%) in the third year (p<0.05). SHPT prevalence was 65.4% in the second year and increased to 83.7% in the sixth year (p<0.05). Patients with low BMD in lumbar, femoral neck, and total proximal femur were older and presented menopausal status more frequently than normal BMD group (p<0.05). Older age was a risk marker for altered BMD in femoral neck (OR=1.185; 95% CI 1.118-1.256) and in total proximal femur (OR=1.158; 95% CI 1.066-1.258), both after adjusting for follow-up and excess weight loss.

CONCLUSION

After 5 years, most bariatric patients presented calcium-vitamin D-PTH axis disruption, in which SHPT was more frequent than hypovitaminosis D. Older patients and menopausal women presented higher rates of low BMD, and older age was a risk marker, especially for low BMD in femoral sites.

摘要

目的

接受 Roux-en-Y 胃旁路术(RYGB)的重度肥胖患者有发生长期维生素 D 缺乏和继发性甲状旁腺功能亢进(SHPT)以及骨代谢疾病的风险。本研究旨在评估接受 RYGB 治疗的患者在中位随访 5 年后钙-维生素 D-PTH 轴和骨密度(BMD)的变化。

材料和方法

维生素 D 缺乏定义为 25-羟维生素 D <20ng/ml,SHPT 定义为 PTH >68pg/ml,同时血清肌酐和钙正常。通过双能 X 射线吸收法(DXA,g/cm)估计 BMD。

结果

我们纳入了 127 名 RYGB 术后患者(51±10.6 岁,87.4%白种人,91.3%女性,52.8%绝经后)。第二年维生素 D 缺乏的患病率最高(41.5%),第三年最低(21.2%)(p<0.05)。第二年 SHPT 的患病率为 65.4%,第六年增加到 83.7%(p<0.05)。腰椎、股骨颈和全股骨近端 BMD 较低的患者年龄较大,绝经状态较正常 BMD 组更常见(p<0.05)。年龄较大是股骨颈(OR=1.185;95%CI 1.118-1.256)和全股骨近端(OR=1.158;95%CI 1.066-1.258)BMD 改变的风险标志物,均在调整随访和超重减轻后。

结论

5 年后,大多数肥胖症患者出现钙-维生素 D-PTH 轴紊乱,其中 SHPT 比维生素 D 缺乏更为常见。年龄较大的患者和绝经后女性的 BMD 较低发生率较高,年龄较大是低 BMD 的风险标志物,尤其是股骨部位的低 BMD。

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