Changes in Bone Mineral Density in Patients With Type 2 Diabetes After Different Bariatric Surgery Procedures and the Role of Gastrointestinal Hormones

Obes Surg. 2020 Jan;30(1):180-188. doi: 10.1007/s11695-019-04127-5.

Abstract

Background: To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism.

Methods: Forty-five patients with T2D (mean BMI 39.4 ± 1.9 kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12 months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined.

Results: After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12 months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN.

Conclusions: mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.

Keywords: Bariatric surgery; Bone mineral density; Gastrointestinal hormones.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Bariatric Surgery* / adverse effects
  • Bariatric Surgery* / methods
  • Bone Density / physiology*
  • Bone Remodeling*
  • Bone and Bones / metabolism
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / metabolism
  • Diabetes Mellitus, Type 2 / surgery*
  • Female
  • Femur Neck
  • Follow-Up Studies
  • Gastrointestinal Hormones / blood
  • Gastrointestinal Hormones / physiology*
  • Ghrelin / blood
  • Glucagon / blood
  • Glucagon-Like Peptide 1 / blood
  • Humans
  • Insulin / blood
  • Male
  • Middle Aged
  • Obesity, Morbid / complications
  • Obesity, Morbid / metabolism
  • Obesity, Morbid / surgery*
  • Treatment Outcome

Substances

  • Gastrointestinal Hormones
  • Ghrelin
  • Insulin
  • Glucagon-Like Peptide 1
  • Glucagon