Exercise Mitigates Bone Loss in Women With Severe Obesity After Roux-en-Y Gastric Bypass: A Randomized Controlled Trial

J Clin Endocrinol Metab. 2019 Oct 1;104(10):4639-4650. doi: 10.1210/jc.2019-00074.

Abstract

Context: Bone loss after bariatric surgery potentially could be mitigated by exercise.

Objective: To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss.

Design: Randomized, controlled trial.

Setting: Referral center for bariatric surgery.

Patients: Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB).

Intervention: Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only).

Outcomes: Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes.

Results: Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck [estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium).

Conclusion: Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass.

Trial registration: ClinicalTrials.gov NCT02441361.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing / metabolism
  • Adult
  • Bone Density
  • Bone Diseases, Metabolic / prevention & control*
  • Bone Remodeling
  • Collagen Type I / metabolism
  • Cortical Bone / diagnostic imaging
  • Cortical Bone / pathology
  • Exercise
  • Exercise Therapy / methods*
  • Female
  • Femur Neck / diagnostic imaging
  • Gastric Bypass*
  • Humans
  • Middle Aged
  • Obesity / surgery*
  • Organ Size
  • Osteopontin / metabolism
  • Pelvic Bones / diagnostic imaging
  • Peptide Fragments / metabolism
  • Peptides / metabolism
  • Postoperative Complications / prevention & control*
  • Procollagen / metabolism
  • Radius / diagnostic imaging

Substances

  • Adaptor Proteins, Signal Transducing
  • Collagen Type I
  • Peptide Fragments
  • Peptides
  • Procollagen
  • SOST protein, human
  • SPP1 protein, human
  • collagen type I trimeric cross-linked peptide
  • procollagen Type I N-terminal peptide
  • Osteopontin

Associated data

  • ClinicalTrials.gov/NCT02441361