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Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women

International Journal of Obesity volume 27, pages 110–116 (2003)Cite this article

Abstract

OBJECTIVE: To evaluate, during the first postoperative year in obese pre-menopausal women, the effects of laparoscopic gastric banding on calcium and vitamin D metabolism, the potential modifications of bone mineral content and bone mineral density, and the risk of development of secondary hyperparathyroidism.

SUBJECTS: Thirty-one obese pre-menopausal women aged between 25 and 52 y with a mean body mass index (BMI) of 43.6 kg/m2, scheduled for gastric banding were included. Patients with renal, hepatic, metabolic and bone disease were excluded.

METHODS: Body composition and bone mineral density (BMD) were measured at baseline, 6 and 12 months after gastric banding using dual-energy X-ray absorptiometry. Serum calcium, phosphate, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, γ-glutamyltransferase, bilirubin, urea, creatinine, uric acid, proteins, parathormone, vitamin D3, IGF-1, IGF-BP3 and telopeptide, as well as urinary telopeptide, were measured at baseline and 1, 3, 6, 9 and 12 months after surgery.

RESULTS: After 1 y vitamin D3 remained stable and PTH decreased by 12%, but the difference was not significant. Serum telopeptide C increased significantly by 100% (P<0.001). There was an initial drop of the IGF-BP3 during the first 6 months (P<0.05), but the reduction was no longer significant after 1 y. The BMD of cortical bone (femoral neck) decreased significantly and showed a trend of a positive correlation with the increase of telopeptides (P<0.06). The BMD of trabecular bone, at the lumbar spine, increased proportionally to the reduction of hip circumference and of body fat.

CONCLUSION: There is no evidence of secondary hyperparathyroidism 1 y after gastric banding. Nevertheless biochemical bone markers show a negative remodelling balance, characterized by an increase of bone resorption. The serum telopeptide seems to be a reliable parameter, not affected by weight loss, to follow up bone turnover after gastroplasty.

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References

  1. Bjorntorp P . Obesity. Lancet 1997; 350: 423–426.

    Article  CAS  Google Scholar 

  2. Mokdad AH . Prevalence of attempting weight loss and strategies for controlling weight. JAMA 1999; 282: 16

    Article  Google Scholar 

  3. Garner MD & Wooley CS . Confronting the failure of behavioural and dietary treatments for obesity. Clin Psychol Rev 1991; 11: 729–780.

    Article  Google Scholar 

  4. Safer DJ . Diet, behaviour modification, and exercise: a review of obesity treatments from a long-term perspective. South Med J 1991; 84: 1470–1474.

    Article  CAS  Google Scholar 

  5. Balsiger BM, Luque-de-Leon E & Sarr MG . Surgical treatment of obesity: who is an appropriate candidate? Mayo Clin Proc 1997; 72: 551–558.

    Article  CAS  Google Scholar 

  6. Consensus Development conference panel. Gastrointestinal surgery for severe obesity: consensus development conference statement. Ann Intern Med 1991; 115: 956–961.

  7. Kral JG . Malabsorptive procedures in surgical treatment of obesity. Gastroenterol Clin N Am 1987; 16: 293–305.

    CAS  Google Scholar 

  8. Compston JE, Vedi S, Gianetta E, Watson G, Civalleri D & Scopinaro N . Bone histomorphometry and vitamin D status after biliopancreatic bypass for obesity. Gastroenterology 1984; 87: 350–356.

    CAS  Google Scholar 

  9. Chapin BL, LeMar HJ, Knodel DH & Carter PL . Secondary hyperparathyroidism following biliopancreatic diversion. Arch Surg 1996; 113: 1048–1052.

    Article  Google Scholar 

  10. Compston JE, Horton LWL & Laker MF et al . Bone disease after jejunoileal bypass for obesity. Lancet 1974; ii: 1–4.

    Google Scholar 

  11. Hey H, Stocholm KH, Lund BI & Sorensen OH . Vitamine deficiency in obese patients and changes in circulating vitamine D metabolites following jejunoileal bypass. Int J Obesity 1982; 6: 473–479.

    CAS  Google Scholar 

  12. Mason EE & Ito C . Gastric bypass and obesity. Surg Clin N Am 1967; 47: 1345–1352.

    Article  CAS  Google Scholar 

  13. Halverson JD . Micronutrient deficiencies after gastric bypass for morbid obesity. Am Surg 1986; 52: 594–598.

    CAS  PubMed  Google Scholar 

  14. Schilling RF, Gohdes PN & Hardie GH . Vitamin B12 deficiency after gastric bypass surgery for obesity. Ann Inter Med 1984; 101: 501–502.

    Article  CAS  Google Scholar 

  15. Shaker JL . Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity. Osteoporosis 1991; 1: 177–181.

    Article  CAS  Google Scholar 

  16. Anderson T, Mc Nair P, Fogh-Anderson N, Nielsen TT, Hylgstrup L & Trabol I . Increased parathyroid hormone as a consequence of changed complex binding of plasma calcium in morbid obesity. Metabolism 1986; 35: 147–151.

    Article  Google Scholar 

  17. Krolner B, Ranlov PJ, Clemmensen T & Nielsen SP . Bone loss after gastroplasty for morbid obesity: side-effect or adptive response to weight reduction? Lancet 1982; i: 956–957.

    Article  Google Scholar 

  18. Nilas L, Christiansen C & Christiansen J . Regulation of vitamin D and calcium metabolism after gastrectomy. Gut 1985; 26: 252–257.

    Article  CAS  Google Scholar 

  19. Cundy T, Evans MC, Kay RG, Dowman M, Wattie D & Reid R . Effects of vertical-banded gastroplasty on bone and mineral metabolism in obese patients. Br J Surgery 1996; 83: 1468–1472.

    Article  CAS  Google Scholar 

  20. Sjostrom CD, Lissner L, Wedel H & Sjostrom L . Reduction in incidence of diabetes, hypertension and lipid distrurbances after intentional weight loss induced by bariatric surgery: the SOS Intervention Study. Obes Res 1999; 7: 477–484.

    Article  CAS  Google Scholar 

  21. Ben-Dov I, Grossman E, Stein A, Shachor D & Gaides M . Marked weight reduction lowers resting and exercise blood pressure in morbidly obese patients. Am J Hypertens 2000; 13: 251–255.

    Article  CAS  Google Scholar 

  22. Cooper PL, Brearles LK, Jamieson AC & Ball MJ . Nutritional consequences of modified vertical gastroplasty in obese subjects. Int J Obes 1999; 23: 382–388.

    Article  CAS  Google Scholar 

  23. Suter M, Giusti V, Héraïef E, Jayet C & Jayet A . Early results of laparoscopic gastric banding compared with open vertical banded gastroplasty. Obes Surg 1999; 9: 374–380.

    Article  CAS  Google Scholar 

  24. Statistical Bulletin Metrop. Life Insurance Co. no. 40. November–December 1959.

  25. Jakicic JM, Donnelly JE, Jawad AF, Jacobsen DJ, Gunderson SC & Pascale R . Association between blood lipids and different measures of body fat distribution: effects of BMI and age. Int J Obes 1993; 17: 131–137.

    CAS  Google Scholar 

  26. Jenson M, Kanaley J & Roust L et al . Assessment of body composition with use of dual-energy x-ray absorptiometry: evaluation and comparison with other methods. Mayo Clinic Proc 1993; 68: 867–873.

    Article  Google Scholar 

  27. Johansson A, Forslund A, Sj!odin A, Mallmin H, Hambraeus L & Ljunghall S . Determination of body composition: a comparison of dual-energy x-ray absorptiometry and hydrodensitometry. Am J Clin Nutr 1993; 57: 323–326.

    Article  CAS  Google Scholar 

  28. Lees B & Stevenson JC . An evaluation of dual-energy x-ray absorptiometry and comparison with dual-photon absorptiometry. Osteoporosis Int 1992; 2: 146–152.

    Article  CAS  Google Scholar 

  29. Pouilles JM, Tremollieres F, Todorovsky N & Ribot C . Precision and sensitivity of dual-energy x-ray absorptiometry in spinal osteoporosis. J Bone Miner Res 1991; 6: 997–1002.

    Article  CAS  Google Scholar 

  30. Rizzoli HD, Thiebaud D, Lippuner K, Allaoua S, Genton L, Luzuy F, Krieg MA, Jaeger P & Slosman DO . Reference data in a Swiss population. Discordance in patient classification using T-score among calcaneum, spine, and femur. J Clin Densitom 2001; 4 (4): 291–298.

    Article  Google Scholar 

  31. Looker AC, Bauer DC, Chesnut CH III, Gundberg CM, Hochberg MC, Klee G, Kleerekoper M, Watts NB & Bell NH . Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporosis International 2000; 11: 467–480.

    Article  CAS  Google Scholar 

  32. Popp-Snijders Clips P & Netelenbos JC . Intra-individual variation in bone resorption markers in urine. Ann Clin Biochem 1996; 33: 347–348.

    Article  Google Scholar 

  33. Blumsohn A & Eastell R . The performance and utility of biochemical markers of bone turnover: do we know enough to use them in clinical practice? Ann Clin Biochem 1997; 34: 449–459.

    Article  Google Scholar 

  34. Sebastian-Gambaro MA, Liron-Hernandez FJ & Fuentes-Arderiu X . Intra- and inter-individual biological variability data bank. Euro J Clin Chem Clin Biochem 1997; 35: 845–852.

    CAS  Google Scholar 

  35. Garnero P, Borel O & Delmas PD . Evaluation of a fully automated serum assay for C-terminal cross-linking telopeptide of type I collagen in osteoporosis. Clin Chem 2001; 47: 694–702.

    CAS  PubMed  Google Scholar 

  36. Reed BY, Zerwekh JE, Sakhaee K, Breslau NA, Gottschalk F & Pak CYC . Serum IGF-1 is low and correlated with osteoblastic surface in idiopathic osteoporosis. J Bone Miner Res 1995; 10: 1218–1224.

    Article  CAS  Google Scholar 

  37. Mohan S . Insulin-like growth factor binding proteins in bone cell regulation. Growth Regul 1993; 1: 67–70.

    Google Scholar 

  38. Johansson AG, Forslund A, Hambraeus L, Blum WF & Ljunghall S . Growth hormone-dependent insulin-like growth factor binding protein is a major determinant of bone mineral density in healthy men. J Bone Miner Res 1994; 9: 915–921.

    Article  CAS  Google Scholar 

  39. Johansson AG, Eriksen EF, Lindh E, Langdahl B, Blum WF, Lindahl A, Ljunggren O & Ljunghall S . Reduced serum levels of the growth hormone-dependent insulin-like growth factor binding protein and a negative bone balance at the level of individual remodelling units in idiopathic osteoporosis in men. J Clin Endocrinol Metab 1997; 82: 2795–2798.

    CAS  PubMed  Google Scholar 

  40. Ljunghall S, Johansson AG, Burman P, Kämpe O, Lindh E & Karlsson FA . Low plasma levels of insulin-like growth factor I (IGF-1) in male patients with idiopathic osteoporosis. J Intern Med 1992; 232: 59–64.

    Article  CAS  Google Scholar 

  41. Riggs BL, Wahner HW & Dunn WL et al . Differential changes in bone mineral density of the appendicular and axial skeleton with aging: relationship to spinal osteoporis. J Clin Invest 1981; 67: 328–335.

    Article  CAS  Google Scholar 

  42. Hattner R, Etker BN & Frost HM . Suggested sequential mode of control of changes in cell behaviour in adult bone remodelling. Ature 1995; 206: 489–490.

    Google Scholar 

  43. Mundy GR . Bone remodelling and mechanism of bone loss in osteoporosis. In: Meunier PJ (ed). Osteoporosis: diagnosis and management, vol 2, Martin Dunitz Ltd; 1998; pp. 17–35.

    Google Scholar 

  44. Van Loan MD, Johnson HL & Barbieri TF . Effect of weight loss on bone mineral content and bone mineral density in obese women. Am J Clin Nutr 1998; 67: 734–738.

    Article  CAS  Google Scholar 

  45. Pietrobelli A, Wang Z, Formica C & Heymsfield SB . Dual-energy x-ray absorptiometry: fat estimation errors due to variation in soft tissue hydration. Am J Physiol 1998; 274: E808–E816.

    CAS  PubMed  Google Scholar 

  46. Tothill P & Avenell A . Errors in dual-energy x-ray absorptiometry of the lumbar spine owing to fat distribution and soft tissue thickness during weight change. Br J Radiol 1994; 667: 71–75.

    Article  Google Scholar 

  47. Spector E, LeBlanc A & Shackelford L . Hologic QDR 2000 whole body scans: a comparison of three combinations of scan modes and analysis software. Osteoporosis Int 1995; 5: 440–445.

    Article  CAS  Google Scholar 

  48. Tothill P, Hannan WJ, Cowen S & Freeman CP . Anomalies in the measurements of changes in total body bone mineral by dual-energy x-ray absorptiometry during weight change. J Bone Miner Res 1997; 12: 1908–1921.

    Article  CAS  Google Scholar 

  49. Farell TJ & Webber E . The error due to fat inhomogeneity in lumbar spine bone mineral measurements. Clin Phys Physiol Meas 1989; 10: 57–64.

    Article  Google Scholar 

  50. Hangartner TN & Johnston CC . Influence of fat on bone measurements with dual-energy absorptiometry. Bone Miner 1990; 9: 71–81.

    Article  CAS  Google Scholar 

  51. Ricci TA, Chowdhury HA, Heymsfield SB, Stahl T, Pierson RN & Shapses SA . Calcium supplementation suppresses bone turnover during weight reduction in postmenopausal women. J Bone Miner Res 1998; 13: 1045–1050.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank Drs MA Krieg and L Portmann for helpful comments, as well as Ms M Berthoud, E Temler, AF Jacquet and F Leresche for technical assistance.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetology and Metabolism, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    N Pugnale & R C Gaillard

  2. Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    V Giusti, E Zysset, E Héraïef & P Burckhardt

  3. Department of Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

    M Suter

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  1. N Pugnale
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Correspondence to V Giusti.

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Pugnale, N., Giusti, V., Suter, M. et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese pre-menopausal women. Int J Obes 27, 110–116 (2003). https://doi.org/10.1038/sj.ijo.0802177

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