Wu Karin C, Wu Po-Hung, Kazakia Galateia, Patel Sheena, Black Dennis M, Lang Thomas F, Kim Tiffany Y, King Nicole J, Hoffmann Thomas J, Chang Hanling, Linfield Gaia, Palilla Sarah, Rogers Stanley J, Carter Jonathan T, Posselt Andrew M, Schafer Anne L
Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
J Clin Endocrinol Metab. 2024 Nov 27. doi: 10.1210/clinem/dgae830.
Roux-en-Y gastric bypass (RYGB) has deleterious effects on bone mass, microarchitecture, and strength. The skeletal effects of sleeve gastrectomy (SG), now the most commonly performed bariatric surgical procedure, are incompletely understood.
We examined changes in bone turnover, areal and volumetric bone mineral density (aBMD, vBMD), and appendicular bone microarchitecture and estimated strength after SG. We compared the results to those previously reported after RYGB, hypothesizing lesser effects after SG than RYGB.
DESIGN, SETTING, PARTICIPANTS: Prospective observational cohort study of 54 adults with obesity undergoing SG at an academic center.
MAIN OUTCOME MEASURE(S): Skeletal characterization with biochemical markers of bone turnover, dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and high-resolution peripheral QCT (HR-pQCT) was performed preoperatively and 6- and 12-months postoperatively.
Over 12 months, mean percentage weight loss was 28.8%. Bone turnover marker levels increased, and total hip aBMD decreased -8.0% (95% CI -9.1%, -6.7%, p<0.01). Spinal aBMD and vBMD declines were larger in postmenopausal women than men. Tibial and radial trabecular and cortical microstructure worsened, as did tibial estimated strength, particularly in postmenopausal women. When compared to data from a RYGB cohort with identical design and measurements, some SG biochemical, vBMD, and radial microstructural changes were smaller, while other changes were not.
Bone mass, microstructure, and strength decrease after SG. Some skeletal parameters change less after SG than after RYGB, while for others, we find no evidence for smaller effects after SG. Postmenopausal women may be at highest risk of skeletal consequences after SG.
Roux-en-Y胃旁路术（RYGB）对骨量、骨微结构和骨强度具有有害影响。袖状胃切除术（SG）是目前最常用的减肥手术，其对骨骼的影响尚未完全明确。
我们研究了SG术后骨转换、面积骨密度和体积骨密度（aBMD、vBMD）的变化，以及附属骨骼的微结构和估计强度。我们将结果与之前报道的RYGB术后结果进行了比较，假设SG术后的影响小于RYGB。
设计、地点、参与者：对54名在学术中心接受SG手术的肥胖成人进行前瞻性观察队列研究。
术前、术后6个月和12个月采用骨转换生化标志物、双能X线吸收法（DXA）、定量计算机断层扫描（QCT）和高分辨率外周QCT（HR-pQCT）对骨骼进行特征分析。
在12个月内，平均体重减轻百分比为28.8%。骨转换标志物水平升高，全髋aBMD下降8.0%（95%CI -9.1%，-6.7%，p<0.01）。绝经后女性脊柱aBMD和vBMD的下降幅度大于男性。胫骨和桡骨的小梁和皮质微结构恶化，胫骨估计强度也恶化，尤其是绝经后女性。与具有相同设计和测量方法的RYGB队列数据相比，SG术后一些生化、vBMD和桡骨微结构变化较小，而其他变化则不然。
SG术后骨量、微结构和强度下降。SG术后一些骨骼参数的变化小于RYGB术后，而对于其他参数，我们没有发现SG术后影响较小的证据。绝经后女性可能是SG术后骨骼不良后果的最高风险人群。
