Skeletal Effects of Sleeve Gastrectomy in Adolescents and Young Adults: A 2-Year Longitudinal Study

• Published in: The journal of clinical endocrinology and metabolism Vol. 108; no. 4; pp. 847 - 857
• Main Authors: Mitchell, Deborah M, Singhal, Vibha, Animashaun, Abisayo, Bose, Amita, Carmine, Brian, Stanford, Fatima C, Inge, Thomas H, Kelsey, Megan M, Lee, Hang, Bouxsein, Mary L, Yu, Elaine W, Bredella, Miriam A, Misra, Madhusmita
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.04.2023
• Subjects: Absorptiometry, Photon; Adolescent; Adolescents; Body weight loss; Bone and Bones; Bone Density - physiology; Bone mineral density; Bone strength; Bones; Children; Clinical; Computed tomography; Density; Dual energy X-ray absorptiometry; Gastrectomy; Gastrointestinal surgery; Health aspects; Humans; Longitudinal Studies; Obesity; Physiological aspects; Porosity; Radius; Radius - diagnostic imaging; Radius - physiology; Surgery; Teenagers; Tibia; Tibia - diagnostic imaging; Tibia - physiology; Type 2 diabetes; Weight control; Young Adult; Young adults; Youth; Massachusetts; bone metabolism; metabolic bariatric surgery; obesity; pediatric
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/clinem/dgac634

Abstract Context Vertical sleeve gastrectomy (VSG) is an increasingly common tool to achieve weight loss and improve metabolic health in adolescents and young adults with obesity, although it may adversely affect bone health. Objective This work aimed to evaluate the effect of VSG on bone health in youth. Methods An observational 2-year study was conducted at a tertiary care center of 66 patients aged 13 to 24 years with moderate-to-severe obesity meeting criteria for VSG. The patients underwent VSG (n = 30) or nonsurgical (n = 36) management per the decision of patient and clinical team. Main outcome measures included dual-energy x-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of bone mineral density (BMD), geometry, and microarchitecture. Results VSG patients achieved 25.3 ± 2.0% weight loss at 2 years (P < .001) while control subjects gained 4.0 ± 2.0% (P = .026). Total hip BMD declined 8.5 ± 1.0% following VSG compared with 0.1 ± 1.0% gain in controls (P < .001), with similar results at the femoral neck (P < .001). Total volumetric BMD (vBMD) decreased both at the distal radius and tibia following VSG (P < .001) driven primarily by trabecular vBMD loss (P < .001). Two-year changes in cortical vBMD did not differ between groups, though cortical porosity decreased following VSG both at the radius and tibia (P = .048 and P < .001). Cortical thickness increased in controls but not in VSG (P = .022 and P = .002 for between-group comparisons at the radius and tibia, respectively). Following VSG, estimated failure load decreased at the radius and did not demonstrate the physiologic increases at the tibia observed in controls. Conclusion VSG leads to progressive changes in bone health over 2 years, and may lead to increased skeletal fragility in adolescents and young adults.