title: Sclerostin levels and changes in bone metabolism after bariatric surgery.
abstract: BACKGROUND
  The role of sclerostin as a key regulator of bone formation remains unknown after Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (SG).
  
  
  OBJECTIVE
  The study objectives were evaluation of sclerostin and Dickkopf-1 (DKK-1) serum levels after surgery and correlations with bone turnover markers (P1NP, CTX), parathyroid hormone (iPTH) and areal bone mineral density (BMD), changes at total body, lumbar spine and total hip.
  
  
  METHODS
  This was a prospective observational single-center two-arm study in premenopausal women with acute adipositas over 24 months.
  
  
  METHODS
  Participants were 52 premenopausal women (40 ± 8 years, BMI 43.4) after RYGB and 38 premenopausal women (41 ± 7 years, BMI 45.7) after SG.
  
  
  METHODS
  Prior to surgery and 1, 3, 6, 9, 12, 18, and 24 months after surgery sclerostin, DKK-1, CTX, P1NP levels and BMD were measured.
  
  
  RESULTS
  Sclerostin, CTX and (to a lesser extent) P1NP increased after surgery and remained elevated during the entire study period (P < 0.001). DKK-1 declined during months 3-9 (P < 0.005) and then remained unchanged, serum phosphate continuously increased (P < 0.001), iPTH remained within the upper normal limit. Sclerostin increases were significantly positively correlated with CTX and P1NP increases and negatively correlated with BMD loss. BMD independently declined regardless of RYGB and SG. Elevations of sclerostin, CTX, P1NP, and phosphate, but not DKK-1 and iPTH, were significant discriminating factors for BMD loss (AUC 0.920).
  
  
  CONCLUSIONS
  Rapid and sustained increases of sclerostin, CTX, and to a lesser extent, P1NP cause an increase in bone metabolism and result in BMD loss at all skeletal sites.
authors.affiliation: St Vincent Hospital, Medical Department II (C.M., R.K., C.M., A.R.N., H.R.), Academic Teaching Hospital of Medical University of Vienna, Stumpergasse 13, Vienna, Austria; Division of Plastic and Reconstructive Surgery, Department of Surgery (G.K.M.), Medical University of Vienna, Vienna, Austria; Department of Pathophysiology and Allergy Research (P.P.), Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna. Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Muschitz
authors.forename: Roland
authors.initials: R
authors.lastname: Kocijan
authors.forename: Christina
authors.initials: C
authors.lastname: Marterer
authors.forename: Arastoo Rahbar
authors.initials: AR
authors.lastname: Nia
authors.forename: Gabriela Katharina
authors.initials: GK
authors.lastname: Muschitz
authors.forename: Heinrich
authors.initials: H
authors.lastname: Resch
authors.forename: Peter
authors.initials: P
authors.lastname: Pietschmann
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000328:Adult; D050110:Bariatric Surgery; D015519:Bone Density; D019485:Bone Morphogenetic Proteins / Q000097:blood*; D016723:Bone Remodeling / Q000502:physiology; D001842:Bone and Bones / Q000378:metabolism*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D005819:Genetic Markers; D006801:Humans; D036341:Intercellular Signaling Peptides and Proteins / Q000097:blood; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism* / Q000601:surgery*; D011184:Postoperative Period
chemical_list: D048868:Adaptor Proteins, Signal Transducing; D019485:Bone Morphogenetic Proteins; C501126:DKK1 protein, human; D005819:Genetic Markers; D036341:Intercellular Signaling Peptides and Proteins; C422903:SOST protein, human