Longitudinal 5-year evaluation of bone density and microarchitecture after Roux-en-Y gastric bypass surgery

• Published in: The journal of clinical endocrinology and metabolism 2018-11, Vol.103 (11), p.4104-4112
• Main Authors: Lindeman, Katherine G, Greenblatt, Logan B, Rourke, Caroline, Bouxsein, Mary L, Finkelstein, Joel S, Yu, Elaine W
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Adult; Bone density; Bone Density - physiology; Bone Diseases, Metabolic - diagnostic imaging; Bone Diseases, Metabolic - epidemiology; Bone Diseases, Metabolic - etiology; Bone Diseases, Metabolic - physiopathology; Bone loss; Bone mineral density; Bone Remodeling - physiology; Bone surgery; Bone turnover; Clinical s; Collagen (type I); Dual energy X-ray absorptiometry; Female; Gastric bypass; Gastric Bypass - adverse effects; Gastric Bypass - methods; Gastrointestinal surgery; Hip; Humans; Longitudinal Studies; Male; Middle Aged; Obesity, Morbid - surgery; Pelvic Bones - diagnostic imaging; Pelvic Bones - physiopathology; Procollagen; Prospective Studies; Radius; Radius - diagnostic imaging; Radius - physiopathology; Spine - diagnostic imaging; Spine - physiopathology; Tibia; Tibia - diagnostic imaging; Tibia - physiopathology; Tomography, X-Ray Computed
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2018-01496

Bone health declines in the initial years after Roux-en-Y gastric bypass (RYGB), but long-term skeletal effects are unclear. To document longitudinal changes in bone mineral density (BMD) and microarchitecture 5 years after RYGB. Prospective 5-year observational study of 21 adults with severe obesity receiving RYGB at an academic medical center. Spine and hip areal BMD were measured by dual-energy X-ray absorptiometry, and trabecular volumetric BMD (vBMD) of the spine was assessed by quantitative CT (QCT). We measured vBMD and microarchitecture of the distal radius and tibia by high-resolution peripheral QCT in a subset of subjects. Serum type I collagen C-terminal telopeptide (CTX) and procollagen type I N-terminal propeptide (P1NP) were also measured. Areal BMD declined by -7.8% ± 7.6% at the spine and -15.3% ± 6.3% at the total hip by 5 years after RYGB (P ≤ 0.001), although the rate of bone loss slowed in later years. Trabecular spine vBMD decreased by -12.1% ± 12.3% by 5 years (P ≤ 0.001). At peripheral sites, vBMD continued to decrease steadily throughout 5 years, with parallel declines in cortical and trabecular microarchitecture, leading to decreases in estimated failure load of -20% and -13% at the radius and tibia, respectively (P < 0.001). Five years after RYGB, CTX and P1NP were 150% and 34% above baseline (P < 0.001 and P = 0.017, respectively). Sustained high-turnover bone loss and bone microarchitectural deterioration occur in the 5 years after RYGB. Adults receiving RYGB warrant assessment of bone health.