Abstract
Background
Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant changes on bone metabolism. The objectives of this study were to evaluate effects of weight loss on bone metabolism after Roux-en Y gastric bypass in patients with morbid obesity.
Methods
Our study included 70 patients with morbid obesity; RYGB was done for all patients. Daily postoperative oral supplementation with 1,000 mg of calcium and 800 IU of vitamin D was done for each patient. Body weight (BW), body mass index (BMI), total body fat, total lean tissue mass, bone mineral content (BMC), bone mineral density (BMD), total bone area (TBA; using dual energy X-ray absorptiometry), serum calcium, parathyroid hormone (PTH), 25-OH vitamin D, 24-h urinary calcium, and bone-specific alkaline phosphatase (BSAP) were assessed preoperatively and 1 year after surgery.
Results
In our study, females comprised 70% of cases. The mean age was 35 ± 8.8 years. One year after RYGB, BW decreased significantly from 132.8 ± 26.5 to 90.3 ± 17.3 kg (p = 0.001). BMI decreased significantly from 48 ± 7.3 to 32.6 ± 4.1 kg/m2 (p = 0.001). BMC decreased significantly from 2,968.6 ± 71.4 to 2,700.8 ± 45.4 g (p = 0.001). BMD decreased significantly from 1.026 ± 0.03 to 1.22 ± 0.015 g/cm2 (p = 0.001). TBA decreased significantly from 2,356.2 ± 35.4 to 2,216.3 ± 43.5 cm2 (p = 0.001). Serum calcium, 24-h urinary calcium, and BSAP were not significantly decreased while 25-OH vitamin D and PTH were not significantly increased after surgery.
Conclusions
From this study, it is shown that RYGBP operation gives very good results as regards reduction of body weight in morbidly obese patients. Postoperative supplementation with calcium and vitamin D partially corrects osteoporosis. Thus, these patients need periodic follow-up for BMD, PTH, calcium, serum vitamin D, and markers of bone resorption and formation specially postmenopausal female.
Similar content being viewed by others
References
Snow V, Barry P, Fitterman N, et al. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2005;142:525–31.
Kushner FR. Micronutrient deficiencies and bariatric surgery. Curr Opin Endocrinol Diabetes. 2006;13:405–11.
Shuster H, Vázquez J. Nutritional concern related to RYGBP what every clinician needs to known. Crit Care Nurs Q. 2005;28(3):227–60.
Ott MT, Fanti P, Malluche HH, et al. Biochemical evidence of metabolic bone disease in women following Roux-in-Y gastric bypass for morbid obesity. Obes Surg. 1992;2:341–8.
Blake M, Fazio V, O’Brien P. Assessment of nutrient intake in association with weight loss after gastric restrictive procedures for morbid obesity. Aust NZ J Surg. 1991;61:195–9.
Coates PS, Fernstrom JD, Fernstrom MH, et al. Gastric bypass surgery for morbid obesity lead to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab. 2004;89(3):1061–5.
Shaker JL. Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity. Osteoporos Int. 1991;1(3):177–81.
Goode LR. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res. 2004;12(1):40–7.
Fujoka K. Follow-up of nutritional and metabolic problems after bariatric surgery. Diabetes Care. 2005;28(2):481–4.
Langlois JA, Mussolino ME, Visser M, et al. Weight loss from maximum body weight among middle-age and alder white women and the risk of hip fracture: the NHANES I epidemiologic follow-up study. Osteoporosis Int. 2001;12:763–8.
Bano G. Reduced bone mineral density after surgical treatment for obesity. Int J Obes Relat Metab Disord. 1999;23(4):361–5.
Parfitt AM, Podenphant J, Villanueva AR, et al. Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: a bone histomorphometric study. Bone 1985;6:211–20.
Compston JE, Vedi S, Gianetta W, et al. Bone histomorphometry and vitamin D status after biliopancreatic bypass for morbid obesity. Gastroenterology 1984;87:350–6.
Hey H, Lund B, Sorensen OH, et al. Delayed fracture healing following jejunoileal bypass surgery for obesity. Calcif Tissue Int. 1982;34:13–5.
Biertho L, Steffen R, Ricklin T, et al. Laparoscopic gastric bypass versus laparoscopic adjustable gastric banding: a comparative study of 1,200 cases. J Am Coll Surg. 2003;197:536–44.
Sugerman HJ, Kellum JM, Engle KM, et al. Gastric bypass for treating severe obesity. Am J Clin Nutr. 1992;55:560S–6S.
National Institutes of Health. Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults—the evidence report. Obes Res. 1998;6(Suppl 2):51S–209S.
Forbes GB. Perspectives on body composition. Curr Opin Clin Nutr Metab Care. 2002;5:25–30.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;13:1724–37.
Maggard MA, Shugarman LR, Suttorp M, et al. Meta analysis: surgical treatment of obesity. Ann Intern Med. 2005;142:547–59.
Gasteyger C, Suter M, Calmes JM, et al. Changes in body composition, metabolic profile and nutritional status 24 months after gastric banding. Obes Surg. 2006;16:243–50.
Garrapa GG, Canibus P, Gatti C, et al. Changes in body composition and insulin sensitivity in severely obese subjects after laparoscopic adjustable silicone gastric banding (LASGB). Med Sci Monit. 2005;11:CR522–8.
Coupaye M, Bouillot JL, Coussieu C, et al. One-year changes in energy expenditure and serum leptin following adjustable silicone gastric banding in obese women. Obes Surg. 2005;15:827–33.
Giusti V, Suter M, Héraïef E, et al. Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg. 2004;14:239–45.
Infanger D, Baldinger R, Branson R, et al. Effect of significant intermediate-term weight loss on serum leptin levels and body composition in severely obese subjects. Obes Surg. 2003;13:879–88.
Strauss BJ, Marks SJ, Growcott JP. Body composition changes following laparoscopic gastric banding for morbid obesity. Acta Diabetol. 2003;40(Suppl 1):266–9.
Sergi G, Lupoli L, Busetto L. Changes in fluid compartments and body composition in obese women after weight loss induced by gastric banding. Ann Nutr Metab. 2003;47:152–7.
Zittel TT, Zeeb B, Maier GW, et al. High prevalence of bone disorders after gastrectomy. Am J Surg. 1997;174:431–8.
El-Kadre LJ, Rocha PR, de Almeida Tinco AC, et al. Calcium metabolism in pre- and postmenopausal morbidly obese women at baseline and after laparoscopic RYGBP. Obes Surg. 2004;14:1062–6.
von Mach MA, Stoeckli R, Bilz S, et al. Changes in bone mineral content after surgical treatment of morbid obesity. Metabolism 2004;53:918–21.
De Prisco C, Levine SN. Metabolic bone disease after gastric bypass surgery for obesity. Am J Med Sci. 2005;329:57–61.
Hamoui N, Kim K, Anthone G, et al. The significance of elevated levels of parathyroid hormone in patient with morbid obesity before and after bariatric surgery. Arch Surg. 2003;138:891–7.
Goldner WS, O’Dorisio TM, Dillon JS, et al. Severe metabolic bone disease as a long-term complication of obesity surgery. Obes Surg. 2002;12:685–92.
Slater GH, Ren CF, Siegel N, et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg. 2004;8:48–55.
Tovey FL, Hall ML, Ell PJ, et al. A review of postgastrectomy bone disease. J Gastroenterol Hepatol. 1992;7:639–645.
Crowley LV, Seay J, Mullin G. Late effects of gastric bypass for obesity. Am J Gastroenterol. 1984;79:850–60.
Bell NH, Epstein S, Green A, et al. Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest. 1985;76:370–3.
Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr. 2004;80(suppl):1706S–9S.
Dawson-Hughes B, Heaney RP, Holick MF, et al. Estimated of optimal vitamin D status. Osteoporosis Int. 2005;16:713–6, Mar 18.
Parikh SJ, Edelman M, Uwaifo GI, et al. The relationship between obesity and serum 1, 25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab. 2004;89:1196–9.
Leonard MB, Shults J, Wilson BA, et al. Obesity during childhood and adolescence augments bone mass and bon dimensions. Am J Clin Nutr. 2004;80:514–23.
Barrera G, Bunout D, Gattas V, et al. A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects. Nutrition 2004;20:769–71.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Mahdy, T., Atia, S., Farid, M. et al. Effect of Roux-en Y Gastric Bypass on Bone Metabolism in Patients with Morbid Obesity: Mansoura Experiences. OBES SURG 18, 1526–1531 (2008). https://doi.org/10.1007/s11695-008-9653-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11695-008-9653-1