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. 2021;14(1):131-140.
doi: 10.1159/000512450. Epub 2020 Dec 17.

Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Julian Bühler  1   2   3 , Silvan Rast  1   2 , Christoph Beglinger  2 , Ralph Peterli  1   2   3 , Thomas Peters  4 , Martina Gebhart  4 , Anne Christin Meyer-Gerspach  1   2 , Bettina Karin Wölnerhanssen  5   6
Affiliations

Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Julian Bühler et al. Obes Facts. 2021.

Abstract

Background: Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) are scarce.

Objective: The aim of this study was to assess body composition and BMD at least 5 years after LSG and LRYGB.

Setting: Department of Endocrinology and Nutrition, St. Claraspital Basel and St. Clara Research Ltd., Basel, Switzerland.

Methods: Bariatric patients at least 5 years after surgery (LSG or LRYGB) were recruited, and body composition and BMD were measured by means of dual-energy X-ray absorptiometry. Data from body composition before surgery were included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone, vitamin D3, alkaline phosphatase, and C-terminal telopeptide, and the individual risk for osteoporotic fracture assessed by the Fracture Risk Assessment Tool score was calculated. After surgery, all patients received multivitamins, vitamin D3, and zinc. In addition, LRYGB patients were prescribed calcium.

Results: A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median body mass index 43.1, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, the percentage total weight loss at follow-up was 26.3% and for LSG 24.1% (p = 0.243). LRYGB led to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T score at the femoral neck below -1, indicating osteopenia. No clinically relevant difference in BMD was found between the groups.

Conclusions: At 6.7 years after surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.

Keywords: Bariatric surgery; Body composition; Bone density; Dual-energy X-ray absorptiometry; Gastric bypass; Sleeve gastrectomy.

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Conflict of interest statement

This investigator-initiated trial was financially supported by the Uniscientia Foundation. Dr. Peterli reports serving as a consultant for Johnson & Johnson. No other authors reported disclosures. The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Violin plot showing the distribution of percent total weight loss at follow-up. Outliers are marked by a thick dot. Percent total weight loss is defined as %TWL = ([initial weight] − [weight at follow-up])/([initial weight]) × 100. LRYGB, laparoscopic Roux-en-Y gastric bypass; LSG, laparoscopic sleeve gastrectomy.
Fig. 2
Fig. 2
Difference in weight loss between treatment groups for a patient with median age. Mean and 95% confidence intervals for the difference between groups are shown for all quantities with a unit of kilograms. Percent fat and trunk-to-leg fat ratio are excluded. Bars that do not overlap the vertical line are significant at the 5% level. LRYGB, laparoscopic Roux-en-Y gastric bypass; LSG, laparoscopic sleeve gastrectomy.
Fig. 3
Fig. 3
Distribution of the parameters of the whole-body scan displayed as violin plots. LRYGB, laparoscopic Roux-en-Y gastric bypass; LSG, laparoscopic sleeve gastrectomy; T/L fat ratio, trunk-to-leg fat ratio.
See this image and copyright information in PMC

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