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RYGB influences indices of bone resorption in type 2 diabetes
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In adults with type 2 diabetes, Roux-en-Y gastric bypass surgery appears to yield an early increase in a fasting marker of bone resorption independent of weight loss, while laparoscopic adjustable gastric banding does not influence measures of bone remodeling over the course of 1 year.
Researcher evaluated adult participants in the SLIMM-T2D trials, two parallel, randomized controlled trials in which participants with type 2 diabetes were assigned to bariatric surgery vs. an intensive, multidisciplinary medical diabetes and weight management program. One trial randomly assigned participants to Roux-en-Y gastric bypass (RYGB) vs. medical management, and the other randomly assigned patients to laparoscopic adjustable gastric banding (LABG) vs. medical management.
In the current study, researchers evaluated adults aged 21 to 65 years from the surgical groups of the studies who took part in a mixed meal tolerance test substudy (RYGB, n = 11; LAGB, n = 8).
The mixed meal tolerance test was conducted at baseline, 10 days and 1 year after the surgery. Researchers measured serum C-terminal telopeptide (CTX), procollagen type 1 and parathyroid hormone during the test, and evaluated changes in 25-hydroxyvitamin D, polypeptide-YY, glucagon-like peptide-1, glucose dependent insuinotropic peptide and insulin.
Both groups had comparable weight loss 10 days after surgery; at 1 year, the RYGB group had lost more weight compared with the LAGB group (P < .001). Despite similar weight loss at day 10, the RYGB group had a significantly higher mean increase in fasting CTX — a marker of bone resorption — compared with the LAGB group (P < .001). A further increase in fasting CTX was seen in the RYGB group whereas there was no change in the LAGB group at 1 year (P < .001). Day 10 levels of procollagen type 1 — a marker of bone formation — remained unchanged in either group, but by year 1 were significantly higher in the RYGB group compared with the LAGB group (P < .001).
Changes in fasting polypeptide-YY were found to be significantly associated with changes in fasting CTX in the RYGB group; changes in PTH and 25-(OH)D were not associated with changes in CTX.
“In contrast to neutral effects of LAGB on bone, RYGB increases bone resorption markers soon after surgery, and in a manner that persists over at least 1 year. ... The lack of change in biochemical parameters of bone metabolism after LAGB is perhaps reassuring in terms of the impact of this procedure on bone health,” the researchers wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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