title: Examining the link between bariatric surgery, bone loss, and osteoporosis: a review of bone density studies.
abstract: As the popularity of bariatric surgery to treat morbid obesity has risen, so has a concern of increased skeletal fragility secondary to accelerated bone loss following bariatric procedures. We reviewed cross-sectional and prospective literature reporting bone density outcomes following bariatric surgical treatment for morbid obesity. Prospective research provides evidence of hip and lumbar spine areal bone mineral density (aBMD) reductions primarily in women despite calcium and vitamin D supplementation. Femoral neck aBMD declines of 9-11% and lumbar spine aBMD reductions up to 8% were observed at the first post-operative year following malabsorptive procedures. Mean T- and Z-scores up to 25 years following surgery remained within normal and healthy ranges. Of those studies reporting development of osteoporosis following gastric bypass, one woman became osteoporotic after 1 year. Despite observed bone loss in the hip region post-surgery, data do not conclusively support increased incidence of osteoporosis or increased fracture risk in post-bariatric patients. However, given the limitations of dual energy X-ray absorptiometry technology in this population and the relative lack of long-term prospective studies that include control populations, further research is needed to provide conclusive evidence regarding fracture outcomes in this population.
authors.affiliation: School of Kinesiology, University of Minnesota, 1900 University Avenue SE, Cooke Hall, Minneapolis, MN 55455, USA. scibo002@umn.edu
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Scibora
authors.forename: Sayeed
authors.initials: S
authors.lastname: Ikramuddin
authors.forename: Henry
authors.initials: H
authors.lastname: Buchwald
authors.forename: Moira A
authors.initials: MA
authors.lastname: Petit
mesh_terms: D015502:Absorptiometry, Photon; D015519:Bone Density; D005260:Female; D005272:Femur Neck / Q000473:pathology; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D011884:Radius / Q000473:pathology; D012307:Risk Factors; D016896:Treatment Outcome