TY - JOUR

T1 - Effects of Gastric Bypass and Gastric Banding on Bone Remodeling in Obese Patients with Type 2 Diabetes

AU - Yu, Elaine W

AU - Wewalka, Marlene

AU - Ding, Su-Ann

AU - Simonson, Donald C

AU - Foster, Kathleen

AU - Holst, Jens J

AU - Vernon, Ashley

AU - Goldfine, Allison B

AU - Halperin, Florencia

PY - 2016/2

Y1 - 2016/2

N2 - CONTEXT: Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banding (LAGB) or mechanisms underlying bone loss after bariatric surgery.OBJECTIVE: To evaluate effects of RYGB and LAGB on fasting and postprandial indices of bone remodeling.DESIGN AND SETTING: Ancillary investigation of a prospective study at 2 academic institutions.PARTICIPANTS: Obese adults aged 21-65 years with type 2 diabetes who underwent RYGB (n=11) or LAGB (n=8).OUTCOMES: Serum C-terminal telopeptide (CTX), procollagen type 1 (P1NP), and parathyroid hormone (PTH) were measured during a mixed meal tolerance test at baseline, 10 days and 1 year after surgery. Changes in 25-hydroxyvitamin D, polypeptide YY (PYY), glucagon-like peptide-1, glucose-dependent insulinotropic peptide, and insulin were also assessed.RESULTS: Fasting CTX increased 10 days after RYGB but not LAGB (+69±23% versus +12±12%, P<0.001), despite comparable weight loss at that time. By 1 year, fasting CTX and P1NP increased more after RYGB than LAGB (CTX +221±60% versus +15±6%, P<0.001; P1NP +93±25% versus -9±10%, P<0.001) and weight loss was greater with RYGB. Changes in CTX were independent of PTH and 25-hydroxyvitamin D but were associated with increases in fasting PYY. Postprandial suppression of CTX was more pronounced after RYGB than LAGB at 10 days and 1 year post-operatively.CONCLUSIONS: RYGB is accompanied by early increases in fasting indices of bone remodeling, independent of weight loss or changes in PTH or 25-hydroxyvitamin D. LAGB did not affect bone markers. PYY and other enterohormonal signals may play a role in RYGB-specific skeletal changes.

AB - CONTEXT: Roux-en-Y gastric bypass (RYGB) leads to high-turnover bone loss, but little is known about skeletal effects of laparoscopic adjustable gastric banding (LAGB) or mechanisms underlying bone loss after bariatric surgery.OBJECTIVE: To evaluate effects of RYGB and LAGB on fasting and postprandial indices of bone remodeling.DESIGN AND SETTING: Ancillary investigation of a prospective study at 2 academic institutions.PARTICIPANTS: Obese adults aged 21-65 years with type 2 diabetes who underwent RYGB (n=11) or LAGB (n=8).OUTCOMES: Serum C-terminal telopeptide (CTX), procollagen type 1 (P1NP), and parathyroid hormone (PTH) were measured during a mixed meal tolerance test at baseline, 10 days and 1 year after surgery. Changes in 25-hydroxyvitamin D, polypeptide YY (PYY), glucagon-like peptide-1, glucose-dependent insulinotropic peptide, and insulin were also assessed.RESULTS: Fasting CTX increased 10 days after RYGB but not LAGB (+69±23% versus +12±12%, P<0.001), despite comparable weight loss at that time. By 1 year, fasting CTX and P1NP increased more after RYGB than LAGB (CTX +221±60% versus +15±6%, P<0.001; P1NP +93±25% versus -9±10%, P<0.001) and weight loss was greater with RYGB. Changes in CTX were independent of PTH and 25-hydroxyvitamin D but were associated with increases in fasting PYY. Postprandial suppression of CTX was more pronounced after RYGB than LAGB at 10 days and 1 year post-operatively.CONCLUSIONS: RYGB is accompanied by early increases in fasting indices of bone remodeling, independent of weight loss or changes in PTH or 25-hydroxyvitamin D. LAGB did not affect bone markers. PYY and other enterohormonal signals may play a role in RYGB-specific skeletal changes.

U2 - 10.1210/jc.2015-3437

DO - 10.1210/jc.2015-3437

M3 - Journal article

C2 - 26600045

VL - 101

SP - 714

EP - 722

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 2

ER -