Bone Changes Post-Sleeve Gastrectomy in Relation to Body Mass and Hormonal Changes
Snimarjot Kaur, Supritha Nimmala, Vibha Singhal, Deborah M Mitchell, Clarissa C Pedreira, Meghan Lauze, Hang Lee, Fatima Cody Stanford, Mary L Bouxsein, Miriam A Bredella, Madhusmita Misra- Endocrinology
- General Medicine
- Endocrinology, Diabetes and Metabolism
Abstract
Objective
To determine mechanisms contributing to impaired bone health in youth 24 months following sleeve gastrectomy (SG)
Design
24-month longitudinal observational study
Methods
Participants included 23 youth undergoing SG and 30 non-surgical controls (NS) 13-25 years old with moderate-to-severe obesity. Subjects underwent fasting labs for bone turnover markers (N-terminal propeptide of type 1 procollagen, C-telopeptide (CTX), sex hormones, enteric peptides, DXA for areal bone mineral density (aBMD) and body composition, high resolution peripheral quantitative CT for volumetric BMD (vBMD) at the distal radius and tibia, and microfinite element analysis for strength estimates.
Results
Groups did not differ for mean age or BMI z-scores. Over 24 months, SG vs. NS had greater reductions in BMI z-scores, spine, hip, and femoral neck aBMD Z-scores (p ≤0.012), greater increases in serum CTX and SHBG (p≤0.039) and decreases in estrone and ghrelin (p≤0.021). Among females, estrone and free androgen index (FAI) decreased (p≤0.022). After controlling for age and sex, decreases in BMI and lean mass were associated with decreases in total hip and femoral neck aBMD Z-scores, decreases in radial total and trabecular vBMD and failure load, and tibial total and trabecular vBMD. Among females, after controlling for age, decreases in estrone were associated with decreases in spine aBMD Z-scores and radial total and trabecular vBMD, and decrease in FAI with decreases in radial failure load.
Conclusion
Reductions in BMI, lean mass and sex steroids over 24 months post-SG are associated with bone loss and could be targeted for preventative or therapeutic interventions.