Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Department of Medicine, Harvard Medical School, Boston, MA, United States.
Eur J Endocrinol. 2023 Sep 1;189(3):346-354. doi: 10.1093/ejendo/lvad121.
To determine mechanisms contributing to impaired bone health in youth 24 months following sleeve gastrectomy (SG).
Twenty-four-month longitudinal observational study.
Participants included 23 youth undergoing SG and 30 non-surgical controls (NS) 13-25 years old with moderate-to-severe obesity. Subjects underwent fasting labs for bone turnover markers (N-terminal propeptide of type 1 procollagen, C-telopeptide (CTX)), sex hormones, sex hormone binding globulin (SHBG), and enteric peptides, DXA for areal bone mineral density (aBMD) and body composition, high-resolution peripheral quantitative CT for volumetric BMD (vBMD) at the distal radius and tibia, and microfinite element analysis for strength estimates.
Groups did not differ for mean age or BMI z-scores. Over 24 months, compared to NS, SG had greater reductions in BMI z-scores, and spine, hip, and femoral neck aBMD Z-scores (P ≤ .012), greater increases in serum CTX and SHBG (P ≤ .039), and greater decreases in estrone and ghrelin (P ≤ .021). Among females, estrone and free androgen index (FAI) decreased (P ≤ .022) in SG vs NS groups. After controlling for age and sex, decreases in BMI and lean mass were associated with decreases in total hip and femoral neck aBMD Z-scores, and decreases in radial total and trabecular vBMD and failure load, and tibial total and trabecular vBMD. Among females, after controlling for age, decreases in estrone were associated with decreases in spine aBMD Z-scores and radial total and trabecular vBMD, and decrease in FAI with decreases in radial failure load.
Reductions in BMI, lean mass, and sex steroids over 24 months post-SG are associated with bone loss and could be targeted for preventative or therapeutic interventions. Clinical trial registration number: The study is registered in ClinicalTrials.gov (NCT02557438).
确定袖状胃切除术（SG）后 24 个月青少年骨健康受损的机制。
24 个月纵向观察研究。
参与者包括 23 名接受 SG 的青少年和 30 名年龄在 13 至 25 岁之间、患有中重度肥胖的非手术对照者（NS）。受试者接受空腹实验室检查，以测量骨转换标志物（1 型前胶原 N 端肽、C 端肽（CTX））、性激素、性激素结合球蛋白（SHBG）和肠肽、双能 X 线吸收法（DXA）测量骨矿物质密度（aBMD）和身体成分、高分辨率外周定量 CT 测量桡骨和胫骨远端容积骨密度（vBMD）、微有限元分析测量强度估计值。
两组的平均年龄或 BMI z 评分无差异。与 NS 相比，SG 在 24 个月时 BMI z 评分下降幅度更大，脊柱、髋部和股骨颈 aBMD Z 评分下降幅度更大（P≤0.012），血清 CTX 和 SHBG 增加幅度更大（P≤0.039），雌酮和胃饥饿素下降幅度更大（P≤0.021）。在女性中，雌酮和游离雄激素指数（FAI）在 SG 组中下降（P≤0.022）。在控制年龄和性别后，BMI 和瘦体重的下降与全髋和股骨颈 aBMD Z 评分的下降以及桡骨总和小梁 vBMD 和失效负荷的下降有关，胫骨总和小梁 vBMD 的下降有关。在女性中，在控制年龄后，雌酮的下降与脊柱 aBMD Z 评分和桡骨总和小梁 vBMD 的下降有关，FAI 的下降与桡骨失效负荷的下降有关。
SG 后 24 个月内 BMI、瘦体重和性激素的下降与骨丢失有关，可能成为预防或治疗干预的目标。临床试验注册号：该研究在 ClinicalTrials.gov（NCT02557438）注册。
