title: Two-year outcomes on bone density and fracture incidence in patients with T2DM randomized to bariatric surgery versus intensive medical therapy.
abstract: OBJECTIVE
  To determine the 2-year outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) vs. intensive medical therapy (IMT) on lean body mass, total bone mass, and bone mineral density (BMD) measures from the STAMPEDE trial.
  
  
  METHODS
  54 subjects (BMI: 36 ± 1 kg/m(2) , age: 48 ± 4 years) with type 2 diabetes (T2DM) (HbA1c : 9.7 ± 2%) were randomized to IMT, RYGB, or SG and underwent DXA at baseline and at 1 and 2 years.
  
  
  RESULTS
  At 2 years, the reduction in BMI was similar after RYGB and SG and was greater than IMT (P < 0.001). Lean mass was reduced by ∼10%, total bone mineral content reduced by ∼8%, and hip BMD reduced by ∼9% in both surgical groups and was significantly greater than IMT despite increases in vitamin D intake in all groups. The change in hip BMD correlated with weight loss (r = 0.84, P < 0.0001) and changes in lean mass (r = 0.74, P < 0.0001) and leptin (r = 0.53, P < 0.0001). Peripheral fractures were self-reported in RYGB (4/18 patients), SG (2/19 patients), and IMT (4/16 patients).
  
  
  CONCLUSIONS
  Surgically induced weight loss is associated with modest reductions in lean mass, bone mineral content, and BMD, despite calcium and vitamin D supplementation in patients with T2DM. Awareness for bone loss is indicated for patients undergoing bariatric procedures.
authors.affiliation: Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA.
authors.forename: Adam H
authors.initials: AH
authors.lastname: Maghrabi
authors.affiliation: Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Kathy
authors.initials: K
authors.lastname: Wolski
authors.affiliation: Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Abood
authors.affiliation: Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Licata
authors.affiliation: Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Claire
authors.initials: C
authors.lastname: Pothier
authors.affiliation: Institutes of Clinical Nutrition and Gastroenterology, The Cleveland Clinic, Ohio, USA.|Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Heart and Vascular Institute, The Cleveland Clinic, Cleveland, Ohio.
authors.forename: Steven
authors.initials: S
authors.lastname: Nissen
authors.affiliation: Bariatric and Metabolic Institute, The Cleveland Clinic, Ohio, USA.
authors.forename: Stacy A
authors.initials: SA
authors.lastname: Brethauer
authors.affiliation: Lerner Research, The Cleveland Clinic, Ohio, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Kirwan
authors.affiliation: Bariatric and Metabolic Institute, The Cleveland Clinic, Ohio, USA.
authors.forename: Philip R
authors.initials: PR
authors.lastname: Schauer
authors.affiliation: Endocrinology and Metabolism Institute, The Cleveland Clinic, Ohio, USA.
authors.forename: Sangeeta R
authors.initials: SR
authors.lastname: Kashyap
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000706:statistics & numerical data; D001823:Body Composition / Q000502:physiology; D015519:Bone Density; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents