Noser Mark-Stefan, Boll Daniel T, Lazaridis Ioannis I, Delko Tarik, Koestler Thomas, Zingg Urs, Potthast Silke
Bariatric Center, Department of Surgery, Limmattal Hospital, Zuerich-Schlieren.
Department of Radiology and Nuclear Medicine, University Hospital Basel, Basel.
J Comput Assist Tomogr. 2025;49(3):385-390. doi: 10.1097/RCT.0000000000001705. Epub 2024 Dec 5.
Bariatric surgery is associated with decreasing bone mineral density (BMD).
To assess the long-term vertebral BMD, measured by opportunistic quantitative CT (QCT), and body mass index (BMI) in patients undergoing proximal laparoscopic Roux-en-Y surgery (LRYGB).
In 62 patients undergoing LRYGB, opportunistic QCT measurements were performed extracting BMD and BMI on day 1 and years 1, 3, and 5 postoperatively.Primarily, one-way analyses of variance were performed on dependent variables BMI and BMD, with imaging interval defined as an independent factor. Student-Newman-Keuls tests performed pairwise comparisons of imaging interval permutations for BMI/BMD.Secondarily, analyses of covariance were used on dependent variables BMI and BMD, with imaging interval as an independent factor and gender/age as well as BMD/BMI, respectively, as covariates.
A total of 227 opportunistic QCT measurements in 62 patients were performed without the need of a phantom or extra software.The BMD decreased substantially and continuously during 1-, 3-, and 5-year follow-up observations, reaching statistical significance in pairwise comparisons for 3- and 5-year follow-up visits compared to initial BMD values as well as the 5-year follow-up visit compared to the 1-year BMD values, P < 0.001. Age and BMI were significant covariates, P < 0.001.The BMI decreased within 1 year and stayed constant until a slight increase at 5 years was observed. Statistical significance in pairwise comparisons for first-year and 3- and 5-year follow-up visits was reached compared to initial BMI values, P < 0.001. For the BMI assessment, none of the covariates reached statistical significance.
Opportunistic QCT is suited for the calculation and follow-up of BMD. There was a continuous decrease of BMD after LRYGB over 5 years post-surgery, whereas BMI decreased in the first year and stayed constant thereafter. Older patients with lower BMI seem particularly prone to an accelerated BMD loss.
减重手术与骨矿物质密度（BMD）降低有关。
通过机会性定量CT（QCT）评估接受近端腹腔镜Roux-en-Y手术（LRYGB）患者的长期椎体BMD及体重指数（BMI）。
对62例行LRYGB手术的患者，在术后第1天、第1年、第3年和第5年进行机会性QCT测量，获取BMD和BMI。首先，对因变量BMI和BMD进行单因素方差分析，将成像间隔定义为独立因素。采用Student-Newman-Keuls检验对BMI/BMD的成像间隔排列进行两两比较。其次，对因变量BMI和BMD进行协方差分析，将成像间隔作为独立因素，性别/年龄以及BMD/BMI分别作为协变量。
对62例患者共进行了227次机会性QCT测量，无需使用体模或额外软件。在1年、3年和5年的随访观察中，BMD显著且持续下降，与初始BMD值相比，3年和5年随访的两两比较以及5年随访与1年BMD值相比均达到统计学显著性，P < 0.001。年龄和BMI是显著的协变量，P < 0.001。BMI在1年内下降，之后保持稳定，直至5年时略有上升。与初始BMI值相比，第1年、第3年和第5年随访的两两比较达到统计学显著性，P < 0.001。对于BMI评估，没有协变量达到统计学显著性。
机会性QCT适用于BMD的计算和随访。LRYGB术后5年内BMD持续下降，而BMI在第1年下降，之后保持稳定。BMI较低的老年患者似乎尤其容易出现BMD加速丢失。
