Sleeve gastrectomy linked to bone strength, BMD decline among adolescents and young adults
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Key takeaways:
- Young people who undergo sleeve gastrectomy have a decrease in bone strength and BMD 1 year after surgery.
- Greater BMI loss after bariatric surgery is associated with a larger decline in bone strength.
Adolescents and young adults with obesity who undergo sleeve gastrectomy have declines in bone strength and volumetric bone mineral density 1 year after surgery, according to study data.
In findings published in The Journal of Bone and Mineral Research, young people with obesity who underwent sleeve gastrectomy lost a mean 34.3 kg of body weight 1 year after surgery compared with no change in weight for those who did not have surgery. The bariatric surgery group also had declines in several bone strength and BMD measures, and those changes were associated with the declines in visceral fat and muscle mass.
“These results indicate that metabolic and bariatric surgery has adverse effects on skeletal integrity of the lumbar spine in youth, and this is significant as bone accrual in the pubertal years is critical for achieving optimal peak bone mass,” Miriam A. Bredella, MD, MBA, director of the center for faculty development, vice chair of faculty affairs and physician investigator in the department of radiology at Massachusetts General Hospital; and professor of radiology at Harvard Medical School, and colleagues wrote. “Increased fracture risk of the lumbar spine has been reported for adults who underwent metabolic and bariatric surgery, and this may be the case for adolescents as well.”
Researchers conducted a prospective study enrolling 59 adolescents and young adults aged 13 to 25 years with a BMI of 35 kg/m2 or higher for adults or an age- and sex-adjusted BMI in the 120% or higher of the 95th percentile for adolescents. Participants who underwent sleeve gastrectomy were placed in the surgery group (n = 29) and those who did not have surgery were placed in a control group (n = 30). The groups were matched for age and sex. Visits for the surgery group were conducted at baseline prior to sleeve gastrectomy and 1 year after surgery. Control participants also attended visits at baseline and 1 year. Screening visits included physical examination, fasting blood tests, CT of the lumbar spine to measure bone strength variables and MRI to measure body composition.
At 1 year, the surgery group lost a mean 34.3 kg of body weight and 12.3 kg/m2 of BMI. There was no change in body weight or BMI for the control group.
The sleeve gastrectomy group had a 5.3% decline in bone strength from baseline to 1 year (P < .001), whereas no change was observed in the control group. Bending stiffness decreased by 2.8% in the surgery group from baseline to 1 year (P < .001), while the control group had a 2.5% increase in bending stiffness (P =.02). Mean volumetric BMD decreased by 4.4% (P < .001) and trabecular volumetric BMD declined 5.7% (P < .001) in the surgery group with no change observed for either measure among control participants. After controlling for the 12-month change in BMI, differences between the surgery and controls groups were observed for bending stiffness (P = .02), mean BMD (P = .04) and cortical BMD (P = .02) were observed.
Among the full study population, the 12-month change in BMI, abdominal fat and thigh muscle were positively associated with 12-month change in vertebral body strength, bending stiffness, average volumetric BMD and trabecular volumetric BMD.
“Our study adds to the growing body of literature suggesting that adolescents who undergo metabolic and bariatric surgery may require postsurgical care to prevent detrimental effects of weight loss on bone accrual,” the researchers wrote. “Current strategies of postsurgical care in adults undergoing metabolic and bariatric surgery include optimizing calcium and vitamin D intake and mechanical loading by weight-bearing activities, and these strategies should be applied to adolescents.”
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