Bone Mineral Density and Turnover After Sleeve Gastrectomy and Gastric Bypass: A Randomized Controlled Trial (Oseberg)

Dag Hofsø, Thor Olav Widerøe Hillestad, Erling Halvorsen, Farhat Fatima, Line Kristin Johnson, Morten Lindberg, Marius Svanevik, Rune Sandbu, Jøran Hjelmesæth, Dag Hofsø, Thor Olav Widerøe Hillestad, Erling Halvorsen, Farhat Fatima, Line Kristin Johnson, Morten Lindberg, Marius Svanevik, Rune Sandbu, Jøran Hjelmesæth

Abstract

Context: Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), is associated with an increased risk of osteoporotic fractures. It is unknown whether RYGB or sleeve gastrectomy (SG) have different effects on bone health.

Objective: To compare changes in bone mineral density and markers of bone turnover 1 year after SG and RYGB.

Design, setting, patients, and interventions: Randomized, triple-blind, single-center trial at a tertiary care center in Norway. The primary outcome was diabetes remission. Patients with severe obesity and type 2 diabetes were randomized and allocated (1:1) to SG or RYGB.

Main outcome measures: Changes in areal bone mineral density (aBMD) and bone turnover markers.

Results: Femoral neck, total hip, and lumbar spine aBMD, but not total body aBMD, decreased significantly more after RYGB (n = 44) than after SG (n = 48) (mean [95% confidence interval] between group differences -2.8% [-4.7 to -0.8], -3.0% [-5.0 to -0.9], -4.2% [-6.4 to -2.1], and -0.5% [-1.6 to 0.6], respectively). The increase in procollagen type 1 N-terminal propeptide (P1NP) and C-telopeptide of type I collagen (CTX-1) were approximately 100% higher after RYGB than after SG (between group difference at 1 year, both P < 0.001). The changes in femoral neck, total hip, and lumbar spine aBMDs and the changes in P1NP and CTX-1 were independently associated with the surgical procedure (all P < 0.05) and not weight change.

Conclusions: Roux-en-Y gastric bypass was associated with a greater reduction in aBMD and a greater increase in bone turnover markers compared with SG. This finding could suggest greater skeletal fragility after RYGB.

Trial registration: ClinicalTrials.gov NCT01778738.

Keywords: bone mineral density; bone turnover; gastric bypass; morbid obesity; sleeve gastrectomy; type 2 diabetes.

© The Author(s) 2020. Published by Oxford University Press on behalf of the Endocrine Society.

Figures

Figure 1.
Figure 1.
Mean percent change in areal bone mineral density (aBMD) from baseline to 1 year after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Bars indicate 95% confidence intervals. P-values were calculated using independent samples t-test.
Figure 2.
Figure 2.
Bone turnover markers, vitamin D, parathyroid hormone, and electrolytes after sleeve gastrectomy and gastric bypass during 1-year follow-up. P-values were derived from linear mixed effects models for repeated measures. Bars indicate 95% confidence intervals. Abbreviations: BALP, bone alkaline phosphatase; CTX-1, C-telopeptide of type I collagen; P1NP, procollagen type 1 N-terminal propeptide; PTH, parathyroid hormone.

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