Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT

• Published in: Calcified tissue international Vol. 98; no. 3; pp. 253 - 262
• Main Authors: Frederiksen, Katrine Diemer, Hanson, Stine, Hansen, Stinus, Brixen, Kim, Gram, Jeppe, Jørgensen, Niklas Rye, Støving, René Klinkby
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.03.2016; Springer Nature B.V
• Subjects: Absorptiometry, Photon; Adult; Anastomosis, Roux-en-Y; Biochemistry; Biomedical and Life Sciences; Bone and Bones - diagnostic imaging; Bone Density; Cell Biology; Endocrinology; Female; Fractures, Bone - diagnosis; Fractures, Bone - diagnostic imaging; Gastric Bypass; Gastrointestinal surgery; Humans; Life Sciences; Linear Models; Male; Middle Aged; Obesity; Obesity, Morbid - diagnostic imaging; Original Research; Orthopedics; Prospective Studies; Radius - diagnostic imaging; Regression Analysis; Risk; Stress, Mechanical; Tibia - diagnostic imaging; Tomography, X-Ray Computed; Weight-Bearing; Obesity; HR-pQCT; Roux-en-Y gastric bypass; Bone strength; Bone microarchitecture
• ISSN: 0171-967X; 1432-0827
• DOI: 10.1007/s00223-015-0091-5

Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and bone architecture assessed using dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), 6 and 12 months after RYGB, and correlate them to changes in selected biochemical markers. A prospective cohort study included 25 morbidly obese patients (10 males, 15 females). Patients were examined with DXA of the hip and spine, HR-pQCT of radius and tibia, and blood sampling before and 6 and 12 months after RYGB. Patients lost in average 33.5 ± 12.1 kg (25.8 ± 8.5 %) in 12 months. In tibia, we found significant loss of total, cortical and trabecular volumetric BMD after 12 months (all p  < 0.001). Microarchitectural changes involved lower trabecular number, increased trabecular separation, and network inhomogeneity along with thinning of the cortex. Estimated bone failure load was decreased after 12 months ( p  = 0.005). We found only minor changes in radius. Results demonstrate significant alterations of bone microarchitecture suggesting an accelerated endosteal resorption along with disintegration of the trabecular structure which resulted in a loss of estimated bone strength in tibia. Such changes may underlie the recently reported increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.