BACKGROUND Sleeve gastrectomy is the most commonly performed weight loss surgery in adolescents with moderate-to-severe obesity. While studies in adults have reported on the deleterious effects of gastric bypass surgery on bone structure and strength estimates, data are lacking for the impact of sleeve gastrectomy on these measures in adolescents. OBJECTIVE To evaluate the impact of sleeve gastrectomy on bone outcomes in adolescents and young adults over 12 months using dual energy X-ray absorptiometry (DXA) and high resolution peripheral quantitative computed tomography (HRpQCT). PARTICIPANTS AND METHODS We enrolled 44 youth 14-22 years old with moderate to severe obesity; 22 underwent sleeve gastrectomy and 22 were followed without surgery (16 females and 6 males in each group). At baseline and 12 months, DXA was used to assess areal bone mineral density (aBMD), HRpQCT of the distal radius and tibia was performed to assess bone geometry, microarchitecture and volumetric BMD (vBMD), and finite element analysis to assess strength estimates (stiffness and failure load). These analyses are adjusted for age, sex, race and the bone measure at baseline. Fasting blood samples were assessed for calcium, phosphorus, and 25(OH) vitamin D (25OHD) levels. RESULTS Over 12-months, the surgical group lost 27.2% of body weight compared to 0.1% in the non-surgical (control) group. Groups did not differ for changes in 25(OH) vitamin D levels (p = 0.186). Compared to controls, the surgical group had reductions in femoral neck and total hip aBMD Z-scores (p ≤ 0.0006). At the distal tibia, compared to controls, the surgical group had reductions in cortical area and thickness and trabecular number, and increases in trabecular area and separation (p ≤ 0.026). At the distal radius, the surgical group had greater reductions in trabecular vBMD, than controls (p = 0.010). The surgical group had an increase in cortical vBMD at both sites (p ≤ 0.040), possibly from a decrease in cortical porosity (p ≤ 0.024). Most, but not all, differences were attenuated after adjusting for 12-month change in BMI. Groups did not differ for changes in strength estimates over time; except that increases in tibial stiffness were lower in the surgical group (p = 0.044) after adjusting for 12-month change in BMI. CONCLUSIONS Over 12 months, weight loss associated with sleeve gastrectomy in adolescents had negative effects on areal BMD and certain HRpQCT parameters. However, bone strength estimates remained stable, possibly because of a simultaneous decrease in cortical porosity and increase in cortical volumetric BMD. Additional research is necessary to determine the relative contribution(s) of weight loss and the metabolic effects of surgery, and whether the observed effects on bone stabilize or progress over time.

中文翻译：

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与非手术对照组相比，肥胖青少年和年轻人袖状胃切除术后的骨骼结局

背景 袖状胃切除术是中度至重度肥胖青少年最常进行的减肥手术。虽然成人研究报告了胃绕道手术对骨骼结构和强度估计的有害影响，但缺乏袖状胃切除术对青少年这些指标影响的数据。目的 使用双能 X 射线骨密度测定法 (DXA) 和高分辨率外周定量计算机断层扫描 (HRpQCT) 评估袖状胃切除术对 12 个月以上青少年和年轻人骨骼结局的影响。参与者和方法 我们招募了 44 名 14-22 岁的中度至重度肥胖青年；22 名接受了袖状胃切除术，22 名未接受手术（每组 16 名女性和 6 名男性）。在基线和 12 个月时，DXA 用于评估面积骨矿物质密度 (aBMD)，执行桡骨远端和胫骨的 HRpQCT 以评估骨骼几何形状、微结构和体积 BMD (vBMD)，以及有限元分析以评估强度估计（刚度和失效载荷）。这些分析根据年龄、性别、种族和基线时的骨骼测量值进行了调整。评估了空腹血样的钙、磷和 25(OH) 维生素 D (25OHD) 水平。结果 在 12 个月的时间里，手术组体重减轻了 27.2%，而非手术组（对照组）体重减轻了 0.1%。组间 25(OH) 维生素 D 水平的变化没有差异 (p = 0.186)。与对照组相比，手术组的股骨颈和全髋骨 aBMD Z 值有所降低 (p ≤ 0.0006)。在胫骨远端，与对照组相比，手术组皮质面积和厚度以及小梁数量减少，小梁面积和分离增加 (p ≤ 0.026)。在桡骨远端，手术组的小梁 vBMD 比对照组有更大的降低 (p = 0.010)。手术组两个部位的皮质 vBMD 均增加 (p ≤ 0.040)，这可能是由于皮质孔隙率降低 (p ≤ 0.024)。大多数（但不是全部）差异在针对 12 个月的 BMI 变化进行调整后减弱。随着时间的推移，力量估计的变化并没有不同；除了在调整 12 个月的 BMI 变化后，手术组胫骨刚度的增加较低 (p = 0.044)。结论 在 12 个月内，青少年袖状胃切除术相关的体重减轻对面积 BMD 和某些 HRpQCT 参数有负面影响。然而，骨强度估计值保持稳定，可能是因为皮质孔隙率同时降低和皮质体积 BMD 增加。有必要进行额外的研究来确定减肥的相对贡献和手术的代谢影响，以及观察到的对骨骼的影响是否随着时间的推移稳定或进展。