title: Chronic increase of bone turnover markers after biliopancreatic diversion is related to secondary hyperparathyroidism and weight loss. Relation with bone mineral density.
abstract: BACKGROUND
  Biliopancreatic diversion (BPD) is the most effective bariatric procedure. Around 70% of these patients have secondary hyperparathyroidism (SH) in the long term as a consequence of calcium and vitamin D malabsorption. This work was aimed to study the influence of SH on bone turnover and its relationship with bone mineral density (BMD).
  
  
  METHODS
  Bone turnover markers were determined in 63 BPD patients and 34 morbidly obese controls. In the BPD group, we also studied the influence of age, loss of weight, common channel length, PTH, vitamin D, and serum calcium on bone turnover as well as its relation with BMD.
  
  
  RESULTS
  BPD patients showed significantly higher PTH, osteocalcin, and beta-CTx levels than controls. In the multivariate regression analysis, only PTH (beta=0.42; P=0.0002), menopausal status (beta=0.31; P=0.007) and the percentage of lost BMI (beta=-0.24; P=0.03) significantly predicted the osteocalcin level (R2=0.33; F=9.56; P<0.0001). Similarly, only PTH (beta=0.39; P=0.0005), menopausal status (beta=0.37; P=0.001) and the percentage of lost BMI (beta=-0.23; P=0.04) significantly predicted the beta-CTx level (R2=0.33; F=9.82; P<0.0001). Osteocalcin and beta-CTx levels correlated negatively with BMD at lumbar spine (r=-0.38, P=0.002 and r=-0.30, P=0.02, respectively).
  
  
  CONCLUSIONS
  Chronic SH and the loss of weight determine a high rate of bone turnover that is associated with decreasing BMD in BPD patients.
authors: Department of Endocrinology and Clinical Nutrition, Hospital Ramón y Cajal, Carretera de Colmenar Km. 9.1, Madrid, Spaine. jbalsa.hrc@salud.madrid.org
authors: José Antonio
authors: JA
authors: Balsa
authors: José I
authors: JI
authors: Botella-Carretero
authors: Roberto
authors: R
authors: Peromingo
authors: Carmen
authors: C
authors: Caballero
authors: Teresa
authors: T
authors: Muñoz-Malo
authors: Juan J
authors: JJ
authors: Villafruela
authors: Francisco
authors: F
authors: Arrieta
authors: Isabel
authors: I
authors: Zamarrón
authors: Clotilde
authors: C
authors: Vázquez
mesh_terms: D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000097:blood* / Q000209:etiology; D001842:Bone and Bones / Q000378:metabolism*; D002908:Chronic Disease; D024042:Collagen Type I / Q000097:blood; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000209:etiology; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D015675:Osteocalcin / Q000097:blood; D010281:Parathyroid Hormone / Q000097:blood; D015431:Weight Loss
chemical_list: D015415:Biomarkers; D024042:Collagen Type I; D010281:Parathyroid Hormone; D015675:Osteocalcin