This article is more than 5 years old. Information may no longer be current.
Bone loss remains elevated 5 years after RYGB vs. sleeve gastrectomy
Click Here to Manage Email Alerts
Adults with uncontrolled type 2 diabetes and obesity treated with Roux-en-Y gastric bypass surgery vs. sleeve gastrectomy or intensive medical therapy had elevated bone turnover markers 5 years later, study data show.
Sangeeta Kashyap, MD, of the department of endocrinology, diabetes and metabolism at Cleveland Clinic, and colleagues evaluated data from the STAMPEDE trial on 95 adults (mean age, 48.5 years) with uncontrolled type 2 diabetes and obesity (mean BMI, 36.5 kg/m2) randomly assigned to intensive medical therapy (n = 25), Roux-en-Y gastric bypass (RYGB; n = 37) or sleeve gastrectomy (n = 33) to determine the 5-year outcomes on bone turnover.
The intensive medical therapy group had higher BMI at 5 years compared with both surgical groups (P < .001). The RYGB group had lower HbA1c (P = .008) and leptin levels (P = .006) compared with the intensive medical therapy group at 5 years.
Five-year C-telopeptide of type 1 collagen (CTX; P = .002) and osteocalcin (P = .001) levels were higher in the RYGB group compared with the other groups. Parathyroid hormone (PTH) increased from baseline in both surgery groups and remained unchanged in the intensive medical therapy group; however, PTH levels did not significantly differ between the groups at 5 years. Percent increases in osteocalcin and CTX (P < .001 for both) were higher in the RYGB group compared with the other groups.
Increases in CTX were strongly related to older age at baseline (P = .014) and increases in PTH (P = .003) in the RYGB group, whereas increases in CTX were related to weight loss (P = .047) and a decrease in BMI (P = .039) in the sleeve gastrectomy group. An increase in osteocalcin was related to white race (P = .046) and an increase in PTH (P = .006) in the RYGB group. In all participants, the decrease in BMI was related to the increase in CTX (P < .001) and an increase in osteocalcin (P < .001).
“Based on our results, the risks associated with a higher degree of chronic bone turnover following RYGB should be weighed against the potential metabolic benefits of this procedure compared with [sleeve gastrectomy],” the researchers wrote. – by Amber Cox
Disclosures: Kashyap reports she receives research support from Covidien, Ethicon EndoSurgery and Janssen. Please see the study for all other authors’ relevant financial disclosures.
Click Here to Manage Email Alerts