Abstract
To study the evolution of the bone mass by ultrasonic transmission after biliopancreatic diversion. Forty eight morbid obese patients were prospectively studied during 36 months following the Larrad biliopancreatic diversion. The bone metabolism was studied by PTHi and the urinary pirydinolines. The bone mass by echography and bone densitometry, which correlate to the levels of PTHi and pyridinolines. After 3 years the bone mass decreased from 50.15 +/− 7.31 kg/m2, preoperatively, to 34.03 +/− 4.53 kg/m2 (p < 0.001). There was an increase of the PTHi value (from 71.4 +/− 79.6 to 91.65 +/− 43.06 pg/ml) (p = 0.01), and the urinary pirydinolines (from 7.93 +/− 4.06 an 11.4 +/− 10.12 nM/mM) (p < 0.05). The ultrasonic transmission speed increased (from 1,990.93 +/− 62.38 to 2,035.25 +/− 53.98 m/s). However, the bone mineral content (BMC) did not show changes (from 3,016.5 +/− 562.8 to 2,909.6 +/− 304.2 g), as well as the Bone Mineral Density (BMD) (of 1,174.2 +/− 98.8 g/cm2). Neither correlation was found between the BMD (r = 0.212; p = 0.6), the BMC (r =−0.125; p = 0.768), and the T-score (r = 0.592, p = 0.093). The study of the bone mass through ultrasonic transmission speed revealed low sensitivity during the assessment of the morbid obese patients. A percentage of cases of osteopenia were observed despite the fact that they are not reflected in the bone content or in the bone mass. Ultrasonic evaluation of bone mass has no value in the morbidly obese, by the clear negative correlation between ultrasound velocity and thickness of soft tissue.
References
Montagnani A, Gonnelli S, Cepollaro C, et al. Usefulness of bone quantitative ultrasound in management of osteoporosis in men. J Clin Densitom. 2001;4:231–7.
Ponteggia M, Ponteggia F, Di Cato L, et al. The usefulness of the quantitative ultrasound to diagnose glucocorticoids induced osteoporosis. Minerva Med. 2002;93:485–90.
Casanova RM, Gutiérrez BP, Ferriz MB, et al. Usefulness of ultrasound in the assessment of bone mineralization in newborns. An Esp Pediatr. 2002;56:443–7.
Baroncelli GI, Battini R, Bertelloni S, et al. Analysis of quantitative ultrasound graphic trace and derived variables assessed at proximal phalanges of the hand in healthy subjects and in patients with cerebral palsy or juvenile idiopathic arthritis. A pilot study. Bone. 2010;46:182–9.
Rose EC, Hagenmuller M, Jonas IE, et al. Validation of speed of sound for the assessment of cortical bone maturity. Eur J Orthod. 2005;27:190–5.
Wuster C, de Terlizzi F, Becker S, et al. Usefulness of quantitative ultrasound in evaluating structural and mechanical properties of bone: comparison of ultrasound, dual-energy X-ray absorptiometry, micro-computed tomography, and mechanical testing of human phalanges in vitro. Technol Health Care. 2005;13:497–510.
Varenna M, Sinigaglia L, Adami S, et al. Association of quantitative heel ultrasound with history of osteoporotic fractures in elderly men: the ESOPO study. Osteoporos Int. 2005;16:1749–54.
Scopinaro N, Gianetta E, Pandolfo N, et al. Bilio-pancreatic bypass. Proposal and preliminary experimental study of a new type of operation for the functional surgical treatment of obesity. Minerva Chir. 1976;31:560–6.
Ott MT, Fanti P, Malluche HH, et al. Biochemical evidence of metabolic bone disease in women following roux-Y gastric bypass for morbid obesity. Obes Surg. 1992;2:341–8.
Wucher H, Ciangura C, Poitou C, et al. Effects of weight loss on bone status after bariatric surgery: association between adipokines and bone markers. Obes Surg. 2008;18:58–65.
Newbury L, Dolan K, Hatzifotis M, et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg. 2003;13:893–5.
Abendschein W, Hyatt G. Ultrasonics and selected physical properties of bone. Clin Orthop. 1970;69:294–301.
Ministero della Salute. Individuazione dei criteri di accesso alla Densitometria Ossea. Roma: Tecniche, Principi Fisici Apparecchiature; 2005.
Rico H, Aguado F, Revilla M, et al. Ultrasound bone velocity and metacarpal radiogrametry in hemodialyzed patients. Miner Electrolyte Metab. 1994;20:103–6.
Fredfeldt KE. Sound velocity in the middle phalanges of the human hand. Acta Radiol Diagn (Stockh). 1986;27:95–6.
Kaufman JJ, Einhorn TA. Ultrasound assessment of bone. J Bone Miner Res. 1993;8:517–25.
Mele R, Masci G, Ventura V, et al. Three-year longitudinal study with quantitative ultrasound at the hand phalanx in a female population. Osteoporos Int. 1997;7:550–7.
Kleerekoper M, Edelson GW. Biochemical studies in the evaluation and management of osteoporosis: current status and future pospects. Endocr Pract. 1996;2:3–19.
Sánchez-Cabezudo C, Diaz-Guerra C, Larrad JA. Analysis of weight loss with the biliopancreatic diversion of Larrad: absolute failures or relative successes? Obes Surg. 2002;12:249–52.
Greenstein RJ, Belachew M. Implantable gastric stimulation (IGS) as therapy for human morbid obesity: report from the 2001 IFSO symposium in Crete. Obes Surg. 2002;12 Suppl 1:3S–5S.
Wortsman J, Matsuoka LY, Chen TC, et al. Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr. 2000;72:690–3.
Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion. World J Surg. 1998;22:936–46.
Hernández ER, Revilla M, Rico H. Contenido mineral óseo en mujeres premenopáusicas y su relación a variables antropométricas. An Anat. 1993;39:27–32.
DeSimone DP, Stevens J, Edwards J, et al. Influence of body habitus and race on bone mineral density of the midradius, hip, and spine in aging women. J Bone Miner Res. 1989;4:827–30.
Felson DT, Zhang Y, Hannan MT, et al. Effects of weight and body mass index on bone mineral density in men and women: the Framinghan study. J Bone Miner Res. 1993;8:567–73.
Kissebah AH, Peiris AN. Biology of regional body fat distribution: relationship to non-insulin-dependent diabetes mellitus. Diab Metab Rev. 1989;5:83–109.
Ribot C, Tremollieres F, Pouilles JM, et al. Influence of the menopause and aging on spinal density in French women. Bone Miner. 1988;5:89–97.
Guney E, Kisakol G, Ozgen G, et al. Effect of weight loss on bone metabolism: comparison of vertical banded gastroplasty and medical intervention. Obes Surg. 2003;13:383–8.
Revilla M, Villa LF, Hernández ER, et al. Influence of weight and gonadal status on total and regional bone mineral content and on weight-bearing and non-weight-bearing bones, measured by dual-energy X-ray absorptiometry. Maturitas. 1997;28:69–74.
Mazess RB, Barden HS. Interrelationships among bone densitometry sites in normal young women. Bone Miner. 1990;11:347–56.
Revilla M, Villa LF, Sánchez-Atrio A, et al. Influence of body mass index on the age-related slope of total and regional bone mineral content. Calcif Tissue Int. 1997;61:134–8.
Riggs BL, O'Fallon WM, Muhs J, et al. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res. 1998;13:168–74.
Horowitz M, Wishart JM, Goh D, et al. Oral calcium suppresses biochemical markers of bone resorption in normal men. Am J Clin Nutr. 1994;60:965–8.
Sairanen S, Karkkainen M, Tahtela R, et al. Bone mass and markers of bone and calcium metabolism in postmenopausal women treated with 1,25-dihydroxyvitamin D (calcitriol) for 4 years. Calcif Tissue Int. 2000;67:122–7.
Larrad-Jiménez A, Díaz-Guerra CS, de Cuadros BP, et al. Short-, mid- and long-term results of Larrad biliopancreatic diversion. Obes Surg. 2007;17:202–10.
Grampp S, Jergas M, Gluer CC, et al. Radiologic diagnosis of osteoporosis. Current methods and perspectives. Radiol Clin North Am. 1993;31:1133–45.
Aguado F, Revilla M, Hernández ER, et al. Behavior of bone mass measurements. Dual energy x-ray absorptiometry total body bone mineral content, ultrasound bone velocity, and computed metacarpal radiogrammetry, with age, gonadal status, and weight in healthy women. Invest Radiol. 1996;31:218–22.
Lees B, Stevenson JC. Preliminary evaluation of a new ultrasound bone densitometer. Calcif Tissue Int. 1993;53:149–52.
Gómez M, Aguado F, Manuel J, et al. Influence of soft tissue (fat and fat-free mass) on ultrasound bone velocity: an in vivo study. Invest Radiol. 1997;32:609–12.
Aguado F. Valores de masa osea por Ultrasonidos en nuestro medio y su correlación con la Radiogrametria y Densitometria de Rayos X. Doctoral thesis, Alcalá Universiy, Madrid; 1996.
Kotzki PO, Buyck D, Hans D, et al. Influence of fat on ultrasound measurements of the os calcis. Calcif Tissue Int. 1994;54:91–5.
Rico H, Gómez M, Aguado F, et al. Impact of weight in obese subjects on bone speed of sound. Invest Radiol. 1999;34:596–9.
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Alcalde, O.L., Duce, A.M., Bustos, F.A. et al. Ultrasonic Value is Not Useful to Detect Bone Changes Following a Biliopancreatic Diversion. OBES SURG 21, 173–178 (2011). https://doi.org/10.1007/s11695-010-0323-8
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DOI: https://doi.org/10.1007/s11695-010-0323-8