Rheumatology Department, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
3D-Shaper Medical, Barcelona, Spain.
Bone. 2025 Jan;190:117270. doi: 10.1016/j.bone.2024.117270. Epub 2024 Oct 3.
We evaluated the impact of bariatric surgery on bone mineral density (BMD) and microarchitecture over one year using dual-energy X-ray absorptiometry (DXA), the trabecular bone score (TBS), and 3D-DXA to assess changes after different surgical techniques. This prospective, single-center study of 153 patients with severe obesity contrasts the effects on bone health of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch/single anastomosis duodeno-ileostomy with sleeve gastrectomy (DS/SADIS). To our knowledge, this is the first study to evaluate patients undergoing DS/SADIS and to incorporate 3D-DXA analysis in the assessment of bone loss. Patients were 81 % female with a mean age of 50 ± 9 years. Fifty-four per cent underwent SG; 16 %, RYGB; and 30 %, DS/SADIS. Our findings revealed a significant decrease in areal BMD at the LS (-3.49 ± 5.44 %), FN (-5.24 ± 5.86 %), and TH (-8.06 ± 5.14 %) one year after bariatric surgery. Bone microarchitecture at the LS assessed by TBS was degraded in 30 % of patients. Proximal femur 3D-DXA analysis showed that surgery-induced bone loss predominantly affects the trabecular compartment (Trabecular volumetric (v) BMD: -8.00 ± 6.57 %) rather than the cortical compartment (Cortical vBMD: -1.37 ± 2.79 %). These results suggest hypoabsorptive and mixed techniques (DS/SADIS and RYGB) were associated with greater BMD loss and deterioration of microarchitecture than restrictive techniques (SG). The primary determinants of bone density and impairment of microarchitecture were the extent of weight loss and the type of surgical procedure. Despite overall bone loss, Z-score assessments indicated that post-surgical bone status remained within or above the average ranges compared to a healthy population, except for TH following DS/SADIS. In conclusion, our research shows differences in the impact of bariatric surgery techniques on bone density and microarchitecture, emphasizing the need for careful postoperative monitoring of bone health, particularly in patients undergoing hypoabsorptive and mixed procedures.
我们使用双能 X 射线吸收法（DXA）、骨小梁评分（TBS）和 3D-DXA 评估了一年中减肥手术对骨密度（BMD）和微结构的影响，以评估不同手术技术后的变化。这项前瞻性、单中心研究纳入了 153 例严重肥胖患者，对比了袖状胃切除术（SG）、Roux-en-Y 胃旁路术（RYGB）和十二指肠转流/单吻合口十二指肠空肠旁路术联合袖状胃切除术（DS/SADIS）对骨健康的影响。据我们所知，这是第一项评估行 DS/SADIS 患者的研究，并将 3D-DXA 分析纳入骨丢失评估中。患者 81%为女性，平均年龄为 50±9 岁。54%的患者行 SG；16%的患者行 RYGB；30%的患者行 DS/SADIS。我们的研究结果显示，减肥手术后 1 年，LS 处的面积 BMD 显著下降（-3.49±5.44%）、FN（-5.24±5.86%）和 TH（-8.06±5.14%）。TBS 评估 LS 处的骨微结构在 30%的患者中恶化。股骨近端 3D-DXA 分析显示，手术引起的骨丢失主要影响松质骨（Trabecular volumetric（v）BMD：-8.00±6.57%）而不是皮质骨（Cortical vBMD：-1.37±2.79%）。这些结果表明，与限制型手术（SG）相比，吸收减少型和混合型手术（DS/SADIS 和 RYGB）与更高的 BMD 丢失和微结构恶化相关。骨密度和微结构损伤的主要决定因素是体重减轻的程度和手术类型。尽管总体骨密度下降，但 Z 评分评估表明，术后骨状态仍保持在健康人群的平均范围内或以上，除了 DS/SADIS 后 TH。总之，我们的研究表明，减肥手术技术对骨密度和微结构的影响存在差异，强调需要术后密切监测骨健康，尤其是在接受吸收减少型和混合型手术的患者中。
