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Controlled Clinical Trial
. 2020 Jan;30(1):290-295.
doi: 10.1007/s11695-019-04154-2.

Effects of Roux-en-Y Gastric Bypass on Osteoclast Activity and Bone Density in Morbidly Obese Patients with Type 2 Diabetes

Laurel L Tangalakis  1 , Lawrence Tabone  2 , Anna Spagnoli  3 , Mike Muehlbauer  4 , Philip Omotosho  3 , Alfonso Torquati  3
Affiliations
Controlled Clinical Trial

Effects of Roux-en-Y Gastric Bypass on Osteoclast Activity and Bone Density in Morbidly Obese Patients with Type 2 Diabetes

Laurel L Tangalakis et al. Obes Surg. 2020 Jan.

Abstract

Introduction: Roux-en-Y gastric bypass (RYGB) is a well-established treatment for morbid obesity and type 2 diabetes. The effects of RYGB on bone metabolism and bone health are largely unknown.

Objective: Determine the changes in osteoclast function and bone density 1 year after RYGB as compared with a control group undergoing a diabetes support and education program (DSE).

Design: A prospective cohort study with patients matched for weight and age assigned to RYGB or DSE.

Setting: Large academic institution.

Patients or other participants: Patients with type 2 diabetes mellitus and morbid obesity (body mass index greater than 35 kg/m2).

Intervention: Subjects either received laparoscopic RYBG or DSE, which consisted of nutritional, exercise, and dietary counseling performed by a certified diabetic educator and a nutritionist three times over a year.

Main outcome measure: Osteoclast activity, bone mineral density.

Results: One year after, intervention subjects undergoing RYGB have a 280% increase in osteoclast activity as compared with a 7.6% increase in the DSE control group (P < 0.001). Furthermore, there was a statistically significant increase in sclerostin levels in subjects undergoing RYGB compared with an increase in the control group. The total bone mineral density was statistically unchanged within 1 year of intervention in both groups. A statistically significant decrease in bone mineral density in the left ribs (decrease of 6.8%, P < 0.05) and lumbar spine (decrease of 4.0%, P < 0.05) was seen 1 year after RYGB.

Conclusions: There is a significant increase in osteoclast activity observed 1 year after RYGB; the long-term clinical implications of this increased bone metabolism are unknown.

Keywords: Bariatric surgery; Bone loss; Bone mineral density; Osteoclast; Roux-en-Y gastric bypass.

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Conflict of interest statement

Conflict of Interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Osteoclastic activity 12 months after Roux-en-Y gastric bypass. Serum concentration (ng/mL) of C-terminal telopeptides of type I collagen (CTX) given as mean ± standard deviation. *Significant difference at 12 months in CTX concentration in subjects who underwent RYGB versus the control group (P < 0.05, 2-tailed t test)
Fig. 2
Fig. 2
Circulating sclerostin in the gastric bypass group. Serum concentration (pmol/L) of sclerostin given as mean ± standard deviation
Fig. 3
Fig. 3
Circulating sclerostin in the control group. Serum concentration (pmol/L) of sclerostin given as mean ± standard deviation
See this image and copyright information in PMC

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