Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini, 1355, 41126, Modena, Italy.
Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy.
J Endocrinol Invest. 2023 Oct;46(10):2133-2146. doi: 10.1007/s40618-023-02066-8. Epub 2023 Mar 27.
Potential negative effects of metabolic surgery on skeletal integrity remain a concern, since long-term data of different surgical approaches are poor. This study aimed to describe changes in bone metabolism in subjects with obesity undergoing both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
A single center, retrospective, observational clinical study on real-world data was performed enrolling subjects undergoing metabolic surgery.
123 subjects were enrolled (males 31: females 92; ages 48.2 ± 7.9 years). All patients were evaluated until 16.9 ± 8.1 months after surgery, while a small group was evaluated up to 4.5 years. All patients were treated after surgery with calcium and vitamin D integration. Both calcium and phosphate serum levels significantly increased after metabolic surgery and remained stable during follow-up. These trends did not differ between RYGB and SG (p = 0.245). Ca/P ratio decreased after surgery compared to baseline (p < 0.001) and this decrease remained among follow-up visits. While 24-h urinary calcium remained stable across all visits, 24-h urinary phosphate showed lower levels after surgery (p = 0.014), also according to surgery technique. Parathyroid hormone decreased (p < 0.001) and both vitamin D (p < 0.001) and C-terminal telopeptide of type I collagen (p = 0.001) increased after surgery.
We demonstrated that calcium and phosphorous metabolism shows slight modification even after several years since metabolic surgery, irrespective of calcium and vitamin D supplementation. This different set point is characterized by a phosphate serum levels increase, together with a persistent bone loss, suggesting that supplementation alone may not ensure the maintenance of bone health in these patients.
代谢手术对骨骼完整性的潜在负面影响仍然令人担忧，因为不同手术方法的长期数据很少。本研究旨在描述肥胖患者接受 Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）后骨代谢的变化。
对接受代谢手术的患者进行了一项单中心、回顾性、观察性的真实世界数据临床研究。
共纳入 123 例患者（男性 31 例，女性 92 例；年龄 48.2±7.9 岁）。所有患者均在术后 16.9±8.1 个月进行评估，而一小部分患者在术后 4.5 年进行评估。所有患者在手术后均接受钙和维生素 D 整合治疗。代谢手术后血清钙和磷水平均显著升高，并在随访期间保持稳定。RYGB 和 SG 之间这些趋势没有差异（p=0.245）。与基线相比，手术后 Ca/P 比值降低（p<0.001），且在随访期间比值持续降低。虽然 24 小时尿钙在所有访视中保持稳定，但 24 小时尿磷在手术后水平较低（p=0.014），这也与手术技术有关。甲状旁腺激素降低（p<0.001），维生素 D（p<0.001）和 I 型胶原 C 端肽（p=0.001）增加。
我们证明，即使在代谢手术后数年，钙磷代谢也会发生轻微改变，而与钙和维生素 D 的补充无关。这种不同的设定点的特征是血清磷水平升高，同时伴有持续的骨丢失，这表明单独补充可能无法确保这些患者的骨骼健康。
