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Observational Study
. 2025 Jul 15;110(8):e2654-e2665.
doi: 10.1210/clinem/dgae830.

Skeletal Effects of Sleeve Gastrectomy, by Sex and Menopausal Status and Compared to Roux-En-Y Gastric Bypass Surgery

Karin C Wu  1   2 , Po-Hung Wu  3 , Galateia Kazakia  3 , Sheena Patel  4 , Dennis M Black  5 , Thomas F Lang  3 , Tiffany Y Kim  1   2 , Nicole J King  2 , Thomas J Hoffmann  5   6 , Hanling Chang  2 , Gaia Linfield  1 , Sarah Palilla  7 , Stanley J Rogers  7 , Jonathan T Carter  7 , Andrew M Posselt  7 , Anne L Schafer  1   2   5
Affiliations
Observational Study

Skeletal Effects of Sleeve Gastrectomy, by Sex and Menopausal Status and Compared to Roux-En-Y Gastric Bypass Surgery

Karin C Wu et al. J Clin Endocrinol Metab. .

Abstract

Context: Roux-en-Y gastric bypass (RYGB) has deleterious effects on bone mass, microarchitecture, and strength. The skeletal effects of sleeve gastrectomy (SG), now the most commonly performed bariatric surgical procedure, are incompletely understood.

Objective: We examined changes in bone turnover, areal bone mineral density (aBMD) and volumetric bone mineral density (vBMD), and appendicular bone microarchitecture and estimated strength after SG. We compared the results to those previously reported after RYGB, hypothesizing lesser effects after SG than RYGB.

Design, setting, participants: Prospective observational cohort study of 54 adults with obesity undergoing SG at an academic center.

Main outcome measures: Skeletal characterization with biochemical markers of bone turnover, dual-energy X-ray absorptiometry, quantitative computed tomography, and high-resolution peripheral QCT was performed preoperatively and 6 and 12 months postoperatively.

Results: Over 12 months, the mean percentage weight loss was 28.8%. Bone turnover marker levels increased, and total hip aBMD decreased -8.0% (95% CI -9.1%, -6.7%, P < 0.01). Spinal aBMD and vBMD declines were larger in postmenopausal women than men. Tibial and radial trabecular and cortical microstructure worsened, as did tibial estimated strength, particularly in postmenopausal women. When compared to data from a RYGB cohort with identical design and measurements, some SG biochemical, vBMD, and radial microstructural changes were smaller, while other changes were not.

Conclusion: Bone mass, microstructure, and strength decrease after SG. Some skeletal parameters change less after SG than after RYGB, while for others we find no evidence for smaller effects after SG. Postmenopausal women may be at the highest risk of skeletal consequences after SG.

Keywords: bariatric surgery; bone mass; bone microstructure; obesity; sleeve gastrectomy.

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Figures

Figure 1.
Figure 1.
Changes in bone mineral density, bone microarchitecture, and estimated strength that were significantly different by sex and menopausal status. (A) Lumbar spine aBMD, (B) lumbar spine vBMD, (C) radius total vBMD, (D) tibia total vBMD, (E) tibia cortical vBMD, (F) radius trabecular separation, (G) tibia trabecular area, (H) tibia cortical thickness, (I) tibia failure load, (J) tibia stiffness, and (K) tibia apparent modulus. Shaded areas represent the 95% confidence intervals.
Figure 2.
Figure 2.
Changes in bone mineral density, bone microarchitecture, and estimated strength that were significantly different by surgical procedure. (A) Lumbar spine vBMD, (B) radius total vBMD, (C) radius trabecular area, (D) radius cortical thickness, (E) tibia trabecular number, and (F) tibia trabecular heterogeneity. Shaded areas represent the 95% confidence intervals.
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