title: Bariatric surgery results in cortical bone loss.
abstract: BACKGROUND
  Bariatric surgery results in bone loss at weight-bearing sites, the mechanism of which is unknown.
  
  
  METHODS
  Twenty-two women (mean body mass index 44 kg/m(2); aged 45 years) who underwent Roux-en-Y gastric bypass (n = 14) and restrictive procedures (n = 8) had measurements of areal bone mineral density by dual-energy x-ray absorptiometry at the lumbar spine, total hip (TH), femoral neck (FN), and one third radius and trabecular and cortical volumetric bone mineral density and microstructure at the distal radius and tibia by high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and 12 months postoperatively.
  
  
  RESULTS
  Mean weight loss was 28 ± 3 kg (P < .0001). PTH rose 23% (P < .02) and 25-hydroxyvitamin D was stable. C-telopeptide increased by 144% (P < .001). Bone-specific alkaline phosphatase did not change. Areal bone mineral density declined at TH (-5.2%; P < .005) and FN (-4.5%; P < .005). By HR-pQCT, trabecular parameters were stable, whereas cortical bone deteriorated, particularly at the tibia: cortical area (-2.7%; P < .01); cortical thickness (-2.1%; P < .01); total density (-1.3%; P = .059); cortical density (-1.7%; P < .01). In multivariate regression, bone loss at the TH and FN were predicted by weight loss. In contrast, only PTH increase predicted cortical deterioration at the tibia. Roux-en-Y gastric bypass patients lost more weight, had more bone loss by dual-energy x-ray absorptiometry and HR-pQCT than those with restrictive procedures, and had declines in cortical load share estimated by finite element analysis.
  
  
  CONCLUSIONS
  After bariatric surgery, hip bone loss reflects skeletal unloading and cortical bone loss reflects secondary hyperparathyroidism. This study highlights deterioration of cortical bone loss as a novel mechanism for bone loss after bariatric surgery.
authors.affiliation: Department of Medicine/Endocrinology, Columbia University of Physicians and Surgeons, New York, New York 10032, USA. es2029@columbia.edu
authors.forename: Emily M
authors.initials: EM
authors.lastname: Stein
authors.forename: Angela
authors.initials: A
authors.lastname: Carrelli
authors.forename: Polly
authors.initials: P
authors.lastname: Young
authors.forename: Mariana
authors.initials: M
authors.lastname: Bucovsky
authors.forename: Chiyuan
authors.initials: C
authors.lastname: Zhang
authors.forename: Beth
authors.initials: B
authors.lastname: Schrope
authors.forename: Marc
authors.initials: M
authors.lastname: Bessler
authors.forename: Bin
authors.initials: B
authors.lastname: Zhou
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.forename: X Edward
authors.initials: XE
authors.lastname: Guo
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Shonni J
authors.initials: SJ
authors.lastname: Silverberg
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects*; D015519:Bone Density / Q000502:physiology*; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology*; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging / Q000209:etiology*; D008875:Middle Aged; D009765:Obesity / Q000000981:diagnostic imaging / Q000601:surgery; D011446:Prospective Studies; D011859:Radiography; D016474:Weight-Bearing