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Bariatric Surgery

Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers

International Journal of Obesity volume 48, pages 575–583 (2024)Cite this article

Subjects

Abstract

Objective

Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort.

Methods

Between 2016 and 2022, BMD was measured by dual energy x-ray absorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison.

Results

In cases (RYGB: mean age 26.8 ± 1.9 years, mean BMI 42.1 ± 9.9 kg/m2, VSG: mean age 25.1 ± 2.1 years, mean BMI 37.1 ± 8.4 kg/m2), compared to controls (mean age 26.5 ± 2.7 years, mean BMI 40.2 ± 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (−10.0% and −6.3%), femoral neck (−9.6% and −5.7%) and ultra-distal radius (−7.9% and −7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (−30% and −26%) and VSG (−15% and −14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS.

Conclusion

BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.

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Fig. 1: Adjusted mean dual energy x-ray absorptiometry (DXA) outcomes for metabolic and bariatric surgery groups and matched controls.
Fig. 2: Adjusted mean peripheral quantitative computed tomography (pQCT) outcomes for metabolic and bariatric surgery groups and matched controls.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge the commitment of the participants in the Teen-LABS study and study personnel.

Funding

Funding

This study was conducted as a cooperative agreement and funded by the National Institute of Diabetes and Digestive and Kidney Diseases (U01 DK072493, UM1 DK072493 and UM1 DK095710). The research was also supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health (Award Number UL1 TR001425). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Halley Wasserman, Todd Jenkins & Heidi J. Kalkwarf

  2. University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Halley Wasserman, Todd Jenkins, Changchun Xie & Heidi J. Kalkwarf

  3. Department of Surgery, Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Thomas Inge & Justin Ryder

  4. Northwestern Feinberg School of Medicine, Chicago, IL, USA

    Thomas Inge & Justin Ryder

  5. Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA

    Marc Michalsky

  6. The Ohio State University, College of Medicine, Columbus, OH, USA

    Marc Michalsky

  7. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Stephanie Sisley

  8. ARS/USDA Children’s Nutrition Research Center, Houston, TX, USA

    Stephanie Sisley

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  1. Halley Wasserman
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Contributions

Halley Wasserman, MD, MS was involved in the study design, review of the DXA and pQCT scans, interpretation of the results, drafting and revising this manuscript and approval of the submitted manuscript. Todd Jenkins was responsible for the statistical analysis and creation of the tables and figures. He helped obtain funding for this work. He was involved in revising this manuscript and approval of the submitted manuscript. Thomas Inge was involved in obtaining funding for this work, study design, interpretation of results, revising this manuscript and approval of the submitted manuscript. Justin Ryder, PhD was involved in the study design, interpretation of results, revising this manuscript and approval of the submitted manuscript. Marc Michalsky, MD, MBA was involved in the data collection, interpretation of results, revising this manuscript and approval of the submitted manuscript. Stephanie Sisley, MD was involved in data collection, interpretation of results, revising this manuscript and approval of the submitted manuscript. Changchun Xie, PhD was involved in the interpretation of results, revising this manuscript and approval of the submitted manuscript. Heidi J. Kalkwarf, PhD was involved in the study design, review of DXA and pQCT scans, data analysis, interpretation of results, drafting and revising this manuscript and approval of the submitted manuscript.

Corresponding author

Correspondence to Halley Wasserman.

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Competing interests

HW – Nothing to disclose. TJ – Nothing to disclose. TI – Consultant for Mediflix and receives author royalties from Wolters Kluwer for UpToDate chapter contribution. JR – Receives a donation of drug and placebo for a clinical trial from Boehringer Ingelheim. MM – Intuitive Surgical, Inc (educational honorarium), Intuitive Surgical, Inc (stock ownership – relationship terminated), Lilly USA, LLC (Pediatric Obesity Advisory Board ad hoc member). SS – Consultant for Rhythm Pharmaceuticals. CX – Nothing to disclose. HJK - Nothing to disclose.

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Wasserman, H., Jenkins, T., Inge, T. et al. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. Int J Obes 48, 575–583 (2024). https://doi.org/10.1038/s41366-023-01453-8

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