title: Bone Structural Changes and Estimated Strength After Gastric Bypass Surgery Evaluated by HR-pQCT.
abstract: Roux-en-Y gastric bypass surgery (RYGB) is an effective treatment of morbid obesity, with positive effects on obesity-related complications. The treatment is associated with bone loss, which in turn might increase fracture risk. The aim of this study was to evaluate changes in bone mineral density (BMD) and bone architecture assessed using dual-energy X-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT), 6 and 12 months after RYGB, and correlate them to changes in selected biochemical markers. A prospective cohort study included 25 morbidly obese patients (10 males, 15 females). Patients were examined with DXA of the hip and spine, HR-pQCT of radius and tibia, and blood sampling before and 6 and 12 months after RYGB. Patients lost in average 33.5 ± 12.1 kg (25.8 ± 8.5 %) in 12 months. In tibia, we found significant loss of total, cortical and trabecular volumetric BMD after 12 months (all p < 0.001). Microarchitectural changes involved lower trabecular number, increased trabecular separation, and network inhomogeneity along with thinning of the cortex. Estimated bone failure load was decreased after 12 months (p = 0.005). We found only minor changes in radius. Results demonstrate significant alterations of bone microarchitecture suggesting an accelerated endosteal resorption along with disintegration of the trabecular structure which resulted in a loss of estimated bone strength in tibia. Such changes may underlie the recently reported increased risk of fracture in bariatric patients after surgery. We only observed bone structural changes in the weight-bearing bone, which indicates that mechanical un-loading is the primary mediator.
authors.affiliation: Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark. katrine.diemer.frederiksen@regionh.dk.
authors.forename: Katrine Diemer
authors.initials: KD
authors.lastname: Frederiksen
authors.affiliation: Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.
authors.forename: Stine
authors.initials: S
authors.lastname: Hanson
authors.affiliation: Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.|Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark.
authors.forename: Stinus
authors.initials: S
authors.lastname: Hansen
authors.affiliation: Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Brixen
authors.affiliation: Department of Endocrinology, Hospital of Southwest Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
authors.forename: Jeppe
authors.initials: J
authors.lastname: Gram
authors.affiliation: Institute of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 19, 5000, Odense C, Denmark.|Research Center for Ageing and Osteoporosis, Department of Clinical Biochemistry, Rigshospitalet, Ndr. Ringvej 57, 2600, Glostrup, Denmark.
authors.forename: Niklas Rye
authors.initials: NR
authors.lastname: Jørgensen
authors.affiliation: Department of Endocrinology, Odense University Hospital, Kløvervænget 6, 1.sal, 5000, Odense C, Denmark.|Center for Eating Disorders, Odense University Hospital, Kløvervænget 6, 8. sal, 5000, Odense C, Denmark.
authors.forename: René Klinkby
authors.initials: RK
authors.lastname: Støving
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015519:Bone Density; D001842:Bone and Bones / Q000000981:diagnostic imaging; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000000981:diagnostic imaging*; D015390:Gastric Bypass; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011884:Radius / Q000000981:diagnostic imaging; D012044:Regression Analysis; D012306:Risk; D013314:Stress, Mechanical; D013977:Tibia / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing
keywords: Bone microarchitecture; Bone strength; HR-pQCT; Obesity; Roux-en-Y gastric bypass