BACKGROUND Accelerated 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. METHODS This 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, active smoking, glucocorticoid use, or weight > 295 lb were excluded. Patients underwent DEXA scans preoperatively and 1 year postoperatively with measurement of total body bone mineral density (BMD) and bone mineral content (BMC) as well as regional site-specific BMD and BMC. RESULTS A total of 28 patients were enrolled. 16 (57.1%) patients underwent RYGB and 12 (42.9%) patients underwent SG. Median preoperative BMI was 44.2 k/m2 (IQR 39.9, 46.6). Median change in BMI at 12 months was - 11.3 k/m2 (IQR - 12.8, - 7.9). A significant reduction in total body BMC was seen when comparing preoperative measurements to postoperative measurements (2358.32 vs 2280.68 grams; p = 0.002). Regional site BMC and BMD significantly decreased in the ribs and spine postoperatively (p = < 0.02) representing the greatest loss in the axial skeleton. Comparing those who underwent RYGB to SG there was no significant difference between the two groups when evaluating changes in total or regional site BMD. CONCLUSION Postmenopausal women were found to have decreased BMD and BMC after RYGB and SG, suggesting that high-risk women may benefit from postoperative DEXA screening. Further study is needed to determine the clinical significance of these findings. It is unknown if these changes in BMD are due to modifiable factors (Vitamin D level, activity level, hormone status, etc.), and whether BMD and BMC is recovered beyond 1 year.

中文翻译：

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确定绝经后妇女减肥手术后骨代谢的变化。


背景技术加速骨质流失是减肥手术后已知的并发症。腹腔镜 Roux-en-Y 胃绕道手术 (RYGB) 后骨矿物质密度显着降低。腹腔镜袖状胃切除术 (SG) 对骨密度的影响目前尚不清楚。对于术前骨质流失风险增加的患者（例如绝经后女性）应考虑这一点。方法 这项前瞻性临床试验纳入了 BMI ≥ 35 k/m2 的绝经后患者，评估 RYGB 或 SG。有骨质疏松史、雌激素替代疗法、主动吸烟、使用糖皮质激素或体重 > 295 磅的患者被排除在外。患者在术前和术后 1 年接受 DEXA 扫描，测量全身骨矿物质密度 (BMD) 和骨矿物质含量 (BMC) 以及区域特定部位的 BMD 和 BMC。结果 共有 28 名患者入组。 16 名 (57.1%) 患者接受了 RYGB，12 名 (42.9%) 患者接受了 SG。术前 BMI 中位数为 44.2 k/m2 (IQR 39.9, 46.6)。 12 个月时 BMI 的中位变化为 - 11.3 k/m2 (IQR - 12.8, - 7.9)。将术前测量值与术后测量值进行比较时，发现全身 BMC 显着减少（2358.32 克 vs 2280.68 克；p = 0.002）。术后肋骨和脊柱的局部部位 BMC 和 BMD 显着下降 (p = < 0.02)，代表中轴骨骼损失最大。比较接受 RYGB 和 SG 的患者，在评估总或局部部位 BMD 的变化时，两组之间没有显着差异。结论 发现绝经后女性在 RYGB 和 SG 后 BMD 和 BMC 降低，表明高危女性可能从术后 DEXA 筛查中受益。 需要进一步研究以确定这些发现的临床意义。目前尚不清楚 BMD 的这些变化是否是由于可改变的因素（维生素 D 水平、活动水平、激素状态等）引起的，以及 BMD 和 BMC 是否会在 1 年后恢复。