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