The Skeletal Consequences of Bariatric Surgery
AbstractPurpose of ReviewThis review outlines the recent findings regarding the impact of bariatric surgery on bone. It explores potential mechanisms for skeletal changes following bariatric surgery and strategies for management.Recent FindingsBone loss following bariatric surgery is multifactorial. Probable mechanisms include skeletal unloading, abnormalities in calciotropic hormones, and changes in gut hormones. Skeletal changes that occur after bariatric surgery are specific to procedure type and persist for several years post-operatively. Studies suggest that while bone loss begins early, fracture risk may be increased later in the post-operative course, particularly after Roux-en-Y gastric bypass (RYGB).SummaryFurther research is needed to assess the extent to which skeletal changes following bariatric surgery result in fragility. Current management should be geared toward prevention of bone loss, correction of nutritional deficiencies, and incorporation of weight bearing exercise. Pharmacologic treatment should be considered for high-risk patients.
AbstractBackgroundAccelerated bone loss is a known complication after bariatric surgery. Bone mineral density has been shown to decrease significantly after Laparoscopic Roux-en-Y gastric bypass (RYGB). Laparoscopic sleeve gastrectomy (SG) effects on bone density are largely unknown. This should be considered for those with increased preoperative risk for bone loss, such as postmenopausal females.MethodsThis prospective clinical trial included postmenopausal patients, with BMI ≥ 35 k/m2, being evaluated for either RYGB or SG. Patients with history of osteoporosis, estrogen hormone replacement therapy...
Conditions: Bariatric Surgery; Osteoporosis; Fractures, Bone; Roux En-Y Gastric Bypass; Sleeve Gastrectomy; Menopause; Premenopause Interventions: Procedure: Roux en Y Gastric Bypass Pre-menopausal; Procedure: Roux en Y Gastric Bypass Post-menopausal; Procedure: Sleeve Gastrectomy Pre-menopausal; Procedure: Sleeve Gastrectomy Post-menopausal Sponsors: University of Alabama at Birmingham; American Society for Metabolic and Bariatric Surgery Not yet recruiting
Bariatric surgery may be associated with reduced bone density, osteoporosis and increased risk of fractures. Distal gastric bypass may increase the risk of bone loss even more due to malabsorption. We have previously shown an increased incidence of secondary hyperparathyroidism two years after distal gastric bypass as compared to standard gastric bypass. Whether these findings translate into increased risk of fractures remains unknown. Bone turnover markers are valid surrogate markers and predictors of future osteoporosis and bone fractures.
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We present the first case of bilateral insufficiency hip fracture after years of bariatric surgery. Although this is a long-term and rare complication, with the high number of gastric bypass performed in the past years, the number of these cases could increase with time. Moreover, it is important as an undiagnosed hip fracture can cause a displacement that could need an arthroplasty, with all the complications that entails. For that reason, this long-term complication highlights the need to reevaluate the optimal follow-up of these patients and the importance to continue monitoring metabolic bone diseases in the prevention...