Andrew R Luhrs, MD, Gerardo Davalos, MD, Reginald Lerebours, MA, Keri A Seymour, MD, Jin S Yoo, MD, Kunoor Jain-Spangler, MD, Ranjan Sudan, MD, Chan Park, MD, A. Daniel Guerron, MD, Dana D Portenier, MD. Duke University Health System
Introduction: Accelerated bone loss is a known complication after bariatric surgery. Bone mineral density (BMD), in the hip and femoral neck, has been shown to decrease significantly after Laparoscopic Roux-en-Y gastric bypass (LRNYGB) as early as six months after operation. This will be of increasing importance as bariatric patients age and should be considered for those with increased preoperative risk for bone loss, such as postmenopausal females. Despite the growing popularity of laparoscopic sleeve gastrectomy (LSG) its effects on bone density have not been studied. This study aims to determine the change in bone metabolism after LSG and LRNYGB in post menopausal females.
Methods: In this prospective cohort study, patients were enrolled if they were postmenopausal, had a BMI ≥ 35k/m2, and were otherwise being scheduled for LRNYGB or LSG. Exclusion criteria included: a documented history of osteoporosis, weight of more than 295 pounds (weight limit of DEXA machine), estrogen hormone replacement therapy within the last year, active smoking, current glucocorticoid use or history of glucocorticoid use for greater than one year. Patients underwent DEXA scans preoperatively and 12 months postoperatively evaluating total BMD and bone mineral content (BMC) and site-specific BMD and BMC of the head, femoral neck, arm, rib, total pelvis, cervical, thoracic, and lumbar spine.
Data were analyzed using Wilcoxon-Rank Sum test and Paired Sample T-test.
Results: A total of 28 patients were enrolled. 16 (57%) patients underwent LRNYGB and 12 (42%) patients underwent LSG. The mean age was 58.1 (SD 5.7). Mean preoperative BMI was 43.1 (SD 5.7). Mean change in BMI at 12 months was 10.3 (SD 6.0). Analyzing all patients, there was a significant difference in preoperative and postoperative total body BMC (2344.3 vs 2289.5 grams; p=0.002). Additionally, postoperative regional BMC significantly decreased postoperatively in the head, arm, rib, trunk, spine, and femur (p=<0.02). Postoperative regional BMD was significantly reduced in the spine (p=<0.001). Comparing LRNYGB vs LSG there was no significant difference between the two groups in total or regional site BMD.
Conclusion: In this small pilot study, postmenopausal women had decreased BMD and BMC one year after LRNYGB and LSG. Further study is required to determine the magnitude to which LRNYGB and LSG effects this observation, whether this effect is due to the modifiable factors (Vitamin D level, activity level, hormone status, etc.), and whether BMD and BMC is recovered beyond one year.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94442
Program Number: S120
Presentation Session: Bariatric IV – Quality and Outcomes
Presentation Type: Podium