Original article
Changes in bone mineral density following laparoscopic sleeve gastrectomy: 2-year outcomes

https://doi.org/10.1016/j.soard.2021.12.019Get rights and content

Highlights

  • •

    We assessed bone mineral density (BMD) in women 2-years post-sleeve gastrectomy (SG).

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    Mean excess weight loss (EWL) achieved at two years was 64.5 ± 21.4%.

  • •

    SG was associated with reduced BMD of the hip and femoral neck.

  • •

    The greatest BMD deterioration occurred predominantly during the first year.

  • •

    Higher EWL was associated with femoral neck and total hip BMD declines.

Abstract

Background

Emerging evidence suggests that sleeve gastrectomy (SG) leads to significant bone mineral density (BMD) losses, but there is a paucity of studies evaluating skeletal consequences beyond 12-months post-operatively.

Objectives

To evaluate BMD changes 2 years postoperatively.

Setting

A university hospital.

Methods

Thirty-three women (mean age: 34.4 ± 12.3 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at baseline and at 3 (M3), 6 (M6), 12 (M12), and 24 (M24) months postoperatively. Data collected included BMD at the total hip, femoral neck, and lumbar spine measured by dual-energy x-ray absorptiometry and anthropometrics, biochemical, nutritional, and physical activity parameters.

Results

At M24, patients achieved a mean body mass index and excess weight loss of 32.4 ± 5.1 kg/m2 and 64.5 ± 21.4%, respectively; however, weight stabilized at M12. Femoral neck BMD decreased significantly from baseline to M24 (.924 ± .124 versus .870 ± .129 g/cm2, P < .001), with no change between M12 and M24 (P = .273). Total hip BMD decreased significantly from baseline to M24 (1.004 ± .105 versus .965 ± .132 g/cm2, P < .001) but increased between M12 and M24 (P = .001). No significant changes were noted in lumbar spine BMD. The percentage of changes in the femoral neck and the total hip BMD from baseline to M24 positively correlated with postoperative excess weight loss (r = .352, P = .045, and r = .416, P = .018, respectively).

Conclusion

Despite notable weight loss, women who underwent SG experienced significant bone loss at the total hip and femoral neck more than 2 years postoperatively. Future studies should investigate intervention strategies to attenuate skeletal deterioration after SG.

Section snippets

Subjects

This prospective cohort study is part of a preregistered randomized clinical trial (Identifier: NCT02483026) of 2-month treatment with preoperative vitamin administration versus standard preoperative care and 12-month follow-up aimed to assess bone density among women who were candidates for SG [8]. This study reports the results of an additional 12 months of follow-up and outcomes of the original RCT. The treatment groups from the original RCT were combined for this study because no difference

Patient characteristics

Of the 62 women who enrolled in the original RCT, 54 (87% of the initial sample) completed the 12M follow-up [8]. During the second year of the study, 8 patients were lost to follow-up because they did not attend the M24 evaluation visit, 10 patients were excluded because they were not interested in undergoing the DXA scan (the primary outcome), and an additional 3 women got pregnant and thus could not undergo the scan and were thereby excluded from the study. Therefore, the final sample

Discussion

Despite the increased recognition that BS has a significant impact and provides important metabolic improvements for patients with morbid obesity, our findings confirm the onset of adverse skeletal health outcomes during a midterm follow-up in women who underwent the SG procedure. We report that over 2 years postoperatively, femoral neck and total hip BMD decreased significantly, with an overall reduction of 5.8% and 3.9% from baseline to the study endpoint, respectively. However, similar to

Conclusion

Despite significant weight loss achievements, women who underwent the SG procedure experienced significant bone loss at the total hip and femoral neck over the midterm of 24 months postoperatively. The greatest deterioration in BMD seems to occur predominantly during the first postoperative year, but further studies should clarify whether the BMD decrease persists and continues to worsen in the longer term after the SG procedure. Collectively, these findings emphasize the need to investigate

Acknowledgments

This study was conducted in partial fulfillment of Shiraz Peretz requirements for the degree of doctor of medicine in the Faculty of Medicine at the Hebrew University of Jerusalem, Israel. The authors thank Dunia Kaluti, Yoav Mintz, Ronit Brodie, and Alon J. Pikarsky for their helpful advice and support during this study.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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    Tair Ben-Porat and Shiraz Peretz contributed equally to the work.

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