Background: Laparoscopic Roux-en-Y gastric bypass is a leading metabolic surgery for obese patients with type 2 diabetes mellitus. However, postoperative nutritional deficiencies and abnormal bone metabolism are possible. In this study, we investigated the mid-term impact on bone metabolism of laparoscopic Roux-en-Y gastric bypass. Methods: This retrospective study involved 238 patients with type-2 diabetes mellitus and obesity who underwent laparoscopic Roux-en-Y gastric bypass in our institution; patients were followed for 3 years. Patients received a calcium supplement (1,200 mg per day), alfacalcidol (0.5 μg per day), and a multivitamin (1 tablet per day), postoperatively. We recorded and analyzed patients' body mass index, and blood levels of 25-hydroxy-Vitamin D, calcium, and parathyroid hormone. Data for 16 patients 6 months postoperatively were selected randomly to evaluate bone-specific alkaline phosphatase and the bone resorption marker, C-terminal crosslinking telopeptide of type I collagen (CTX-1). Results: Of the 238 patients, 111 were women, and 127 were men (mean age: 46.91±12.03 years; mean body mass index: 31.37 kg/m2). 25-hydroxy Vitamin D3 levels did not change (P>0.05) compared with preoperative levels during the 3-year follow-up. Parathyroid hormone (PTH) levels increased (P<0.05), while serum calcium decreased (P<0.05). Patients' body mass index decreased sharply 3 months postoperatively (preoperative vs. postoperative mean: 31.37±3.52 vs. 25.60±2.86, respectively; P<0.05). We saw no decrease in 25-hydroxy Vitamin D3 levels with supplementation, postoperatively. CTX-1 and bone-specific alkaline phosphatase levels showed no significant changes comparing pre- A nd postoperative levels at 6-, 12-, and 24 months (P>0.05). However, CTX-1 levels increased in the first 12 months postoperatively, then decreased in the second year; bone alkaline phosphatase levels increased gradually. Conclusions: Laparoscopic Roux-en-Y gastric bypass is effective for weight loss, but also has an impact on bone metabolism, which increases the risk of fracture. Our results highlight the importance of regular follow-ups and full-dose calcium and vitamin supplementation, postoperatively.
|Number of pages||8|
|Journal||Translational Cancer Research|
|State||Published - Apr 1 2020|
Bibliographical noteFunding Information:
Funding: The current study was supported by the National Key R&D Program of China (2016YFA0502003), Science Foundation of Shanghai Municipal Commission of Health and Family Planning for Young Scholar, “The mechanism of improving diabetic atherosclerosis by down-regulation of LOX-1 after Roux-en-Y gastric bypass” Grant Number: 20164Y0145 and Science Foundation of Shanghai Municipal Commission of Health and Family Planning, “A prospective study for evaluating clinical results of treating type 2 diabetes with Roux-en-Y gastric bypass”, Grant
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- Metabolic bone diseases
- Morbid obesity
- Roux-en-y gastric bypass
- Type 2 diabetes mellitus
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging
- Cancer Research