Journal of Clinical Medicine (Jun 2020)

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial

  • Fernando Guerrero-Pérez,
  • Anna Casajoana,
  • Carmen Gómez-Vaquero,
  • Nuria Virgili,
  • Rafael López-Urdiales,
  • Laura Hernández-Montoliu,
  • Jordi Pujol-Gebelli,
  • Javier Osorio,
  • Anna Prats,
  • Anna Vidal-Alabró,
  • Manuel Pérez-Maraver,
  • Sonia Fernández-Veledo,
  • Joan Vendrell,
  • Nuria Vilarrasa

DOI
https://doi.org/10.3390/jcm9061830
Journal volume & issue
Vol. 9, no. 6
p. 1830

Abstract

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There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.

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