The Impact of Vitamin D, Calcium, Protein Supplementation, and Physical Exercise on Bone Metabolism After Bariatric Surgery: The BABS Study.
Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are common and effective methods to treat severe obesity, but these procedures can adversely influence bone metabolism and areal bone mineral density (aBMD). This was a prospective 24-month single-center interventional two-arm study in 220 women and similarly aged men (median age 40.7 years) with a body mass index (BMI) >38 kg/m(2) after RYGB and SG procedures. Patients were randomized into: 1) an intervention group receiving: 28,000 IU cholecalciferol/wk for 8 weeks before bariatric surgery, 16,000 IU/wk and 1000 mg calciummonocitrate/d after surgery, daily BMI-adjusted protein supplementation and physical exercise (Nordic walking, strength perseverance, and equipment training); 2) a non-intervention group: no preoperative loading, nutritional supplementation, or obligatory physical exercise. At study endpoint, when comparing the intervention group to the non-intervention group, the relative percentage changes of serum levels of sclerostin (12.1% versus 63.8%), cross-linked C-telopeptide (CTX, 82.6% versus 158.3%), 25-OH vitamin D (13.4% versus 18.2%), phosphate (23.7% versus 32%, p < 0.001 for all), procollagen type 1 amino-terminal propeptide (P1NP, 12% versus 41.2%), intact parathyroid hormone (iPTH, -17.3% versus -7.6%), and Dickkopf-1 (-3.9% versus -8.9%, p < 0.05 for all) differed. The decline in lumbar spine, total hip and total body aBMD, changes in BMI, lean body mass (LBM), as well as changes in trabecular bone score (TBS) values (p < 0.005 for all) were less, but significantly, pronounced in the intervention group. We conclude that vitamin D loading and ongoing vitamin D, calcium, and BMI-adjusted protein supplementation in combination with physical exercise decelerates the loss of aBMD and LBM after bariatric surgery. Moreover, the well-known increases of bone turnover markers are less pronounced.
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.
Christian
C
Muschitz
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.
Roland
R
Kocijan
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.
Judith
J
Haschka
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Afrodite
A
Zendeli
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Thomas
T
Pirker
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.
Corinna
C
Geiger
St. Vincent Hospital, Department of Dietetics, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Andrea
A
Müller
St. Vincent Hospital, Department of Dietetics, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Bettina
B
Tschinder
Optimal Essen e.U, Vienna, Austria.
Annemarie
A
Kocijan
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Christina
C
Marterer
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.
Arastoo
A
Nia
Division of Plastic and Reconstructive Surgery, Department of Surgery, the Medical University of Vienna, Vienna, Austria.
Gabriela Katharina
GK
Muschitz
St. Vincent Hospital, Department II, Academic Teaching Hospital of the Medical University of Vienna, Vienna, Austria.|Karl Landsteiner Institute for Gastroenterology and Rheumatology, Vienna, Austria.
Heinrich
H
Resch
Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, the Medical University of Vienna, Vienna, Austria.
Peter
P
Pietschmann
D015502:Absorptiometry, Photon; D000328:Adult; D050110:Bariatric Surgery; D015415:Biomarkers / Q000378:metabolism; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D002136:Calcium, Dietary / Q000494:pharmacology*; D003710:Demography; D004044:Dietary Proteins / Q000494:pharmacology*; D019587:Dietary Supplements; D015444:Exercise; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D011788:Quality of Life; D014807:Vitamin D / Q000494:pharmacology*
D015415:Biomarkers; D002136:Calcium, Dietary; D004044:Dietary Proteins; D014807:Vitamin D
BIOCHEMICAL MARKERS OF BONE TURNOVER; BONE-FAT INTERACTIONS; CLINICAL TRIALS; DXA