Osteoporosis Center, Endocrinology and Metabolism Service, Internal Medicine Ward, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9124001, Israel.
Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem 9124001, Israel.
Nutrients. 2023 Aug 7;15(15):3481. doi: 10.3390/nu15153481.
Bariatric surgery (BS) can have negative effects on bone health. Bone microarchitecture quality evaluation using the trabecular bone score (TBS) has not been described in patients after sleeve gastrectomy (SG). To test the hypothesis that the TBS is clinically useful for this population, we evaluated changes in bone mineral density (BMD) and the TBS in a longitudinal cohort study following SG. The measurements before surgery and after 12 and 24 postoperative months were as follows: weight, height, BMI, waist circumference (WC), BMD and TBS. The results at baseline showed the following: a mean BMI of 43 ± 0.56, TBS of 1.25 ± 0.02, lumbar spine BMD T-score of -0.4 ± 0.93, TBS T-score of -2.30 ± 0.21, significantly lower than BMD-T-score, and associated with a BMD-T-TBS-T gap (T-gap) of -2.05 ± 1.26 (-0.24 ± 0.13). One year after surgery, the TBS had significantly improved (+12.12% ± 1.5), leading to a T-gap of -0.296 ± 0.14, which remained stable at 2 years post-surgery. A correlation analysis revealed a significant negative correlation between the T-gap and WC (r = -0.43 = 0.004). Our interpretation is that abdominal fat may interfere with image acquisition via increased tissue thickness, leading to a false low TBS at baseline. In conclusion, TBS should be interpreted with caution in patients with obesity and elevated WC. Additionally, we show that after SG, the LS microarchitecture measured using the TBS is partially degraded in up to 25% of patients. Further studies are warranted to assess hip bone microarchitecture changes after bariatric surgery.
减重手术（BS）可能对骨骼健康产生负面影响。使用骨小梁评分（TBS）评估袖状胃切除术（SG）后的患者骨小梁微结构质量尚未描述。为了验证 TBS 对该人群具有临床意义的假设，我们在 SG 后进行了一项纵向队列研究，评估了骨密度（BMD）和 TBS 的变化。手术前、术后 12 个月和 24 个月的测量值如下：体重、身高、BMI、腰围（WC）、BMD 和 TBS。基线时的结果如下：平均 BMI 为 43 ± 0.56，TBS 为 1.25 ± 0.02，腰椎 BMD T 评分为-0.4 ± 0.93，TBS T 评分为-2.30 ± 0.21，显著低于 BMD-T 评分，且与 BMD-T-TBS-T 间隙（T 间隙）为-2.05 ± 1.26（-0.24 ± 0.13）。手术后 1 年，TBS 显著改善（+12.12% ± 1.5），导致 T 间隙为-0.296 ± 0.14，术后 2 年保持稳定。相关性分析显示 T 间隙与 WC 呈显著负相关（r = -0.43 = 0.004）。我们的解释是，腹部脂肪可能通过增加组织厚度干扰图像采集，导致基线时 TBS 偏低。总之，在肥胖和 WC 升高的患者中，TBS 的解读应谨慎。此外，我们表明，在 SG 后，多达 25%的患者使用 TBS 测量的 LS 微结构部分受损。需要进一步研究来评估减重手术后髋骨微结构的变化。
