Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun;20(2):315-321.
doi: 10.1007/s42000-020-00254-2. Epub 2020 Nov 5.

Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women

Sotirios Volonakis  1 , Vasiliki Koika  1 , George Tzavelas  2 , Marina Skopeliti  1 , George Skroubis  3 , Fotis Kalfarentzos  3 , Theodore Alexandrides  4
Affiliations

Adequate vitamin D supplementation does not ameliorate bone loss following long limb-biliopancreatic diversion in morbidly obese women

Sotirios Volonakis et al. Hormones (Athens). 2021 Jun.

Abstract

Objectives: The objective of this study is to investigate the effect of adequate vitamin D supplementation on bone mineral density (BMD) following long limb-biliopancreatic diversion (LL-BPD), a malabsorptive bariatric operation.

Background: Marked weight loss following bariatric surgery is associated with significant decrease in BMD, attributed to the weight loss and to nutritional, mineral, and vitamin D deficiencies resulting in secondary hyperparathyroidism.

Methods: Two groups, of 35 and 37 healthy, obese (BMI, 50.4 + 6.6 and 46.5 + 4.8 g/cm2), premenopausal, normally menstruating women underwent LL-BPD. Both groups received high-calcium diets, 600 IU of vitamin D, and 1000 mg elemental calcium daily, while group B received an extra dose of vitamin D (10,000 IU/day) during the first postoperative month, followed by dose adjustment in order to maintain 25OHD concentration higher than 30 μg/L. Areal BMD (aBMD) was measured at the lumbar spine preoperatively and 1 year postoperatively.

Results: One year postoperatively, BMI decreased by approximately 19 kg/m2 in both groups, while 25-OH-vitamin D levels did not change in group A (18.7 + 9.1 to 20.2 + 13.0 μg/L, (p = 0.57)) and increased in group B (15.58 ± 5.73 to 52.97 ± 15.46 μg/L, (p = < 0.001). PTH levels increased in group A (from 38.5 ± 12.2 to 51.2 ± 32.8 pg/ml) (p = 0.047) and decreased in group B (from 51.61 ± 18.7 to 45.1 ± 17.8 pg/ml) (p = 0.042). Lumbar spine aBMD decreased similarly in both groups (p = 0.311, for the comparison between groups) from 1.198 + 0.14 to 1.103 + 0.15 g/cm2 in group A (p < 0.001) and from 1.157 + 0.14 to 1.076 + 0.14 g/cm2 in group B (p < 0.001) and Z-score from 0.93 + 0.97 to 0.19 + 1.02, (p < 0.001) and from 1.15 + 1.29 to 0.419 + 1.28, (p < 0.001), respectively.

Conclusions: LL-BPD leads to similar and significant bone mass reduction 1 year postoperatively, irrespective of adequate vitamin D replacement and in the absence of secondary hyperparathyroidism.

Keywords: Bariatric surgery; Bone mass; Obesity; Secondary hyperparathyroidism; Vitamin D.

PubMed Disclaimer

References

    1. Lupoli R, Lembo E, Saldalamacchia G, Avola CK, Angrisani L, Capaldo B (2017) Bariatric surgery and long-term nutritional issues. World J Diabetes 8:464–474 - DOI
    1. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF (2000) Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 72:370–373 - DOI
    1. Johansson H, Kanis JA, Odén A et al (2014) A meta-analysis of the association of fracture risk and body mass index in women. J Bone Miner Res 29:223–233 - DOI
    1. Parfitt AM, Pødenphant J, Villanueva AR, Frame B (1985) Metabolic bone disease with and without osteomalacia after intestinal bypass surgery: a bone histomorphometric study. Bone 6:210–220 - DOI
    1. Gregory NS (2017) The effects of bariatric surgery on bone metabolism. Endocrinol Metab Clin N Am 46:105–116 - DOI

LinkOut - more resources