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Bariatric Surgery

The curious fate of bone following bariatric surgery: bone effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in mice

International Journal of Obesity volume 44, pages 2165–2176 (2020)Cite this article

Subjects

Abstract

Background

Bone loss and increased fracture risk following bariatric surgery has been reported. We investigated whether the two most commonly performed surgeries, sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), lead to bone loss. In addition, we examined whether fortification of the diet with calcium citrate prevents bone loss.

Methods

We used mouse models for SG and RYGB and compared bone loss with a group of sham mice with similar weight loss. All groups were switched at the time of surgery to a low-fat diet (LFD). We also examined whether fortification of the diet with calcium citrate and vitamin D was able to prevent bone loss.

Results

At 2 weeks we observed no major bone effects. However, at 8 weeks, both trabecular and cortical bone were lost to the same extent after SG and RYGB, despite increased calcium absorption and adequate serum levels of calcium, vitamin D, and parathyroid hormone (PTH). Diet fortification with calcium citrate and vitamin D was able to partially prevent bone loss.

Conclusions

Both SG and RYGB lead to excess bone loss, despite intestinal adaptations to increase calcium absorption. Fortifying the diet with calcium citrate and vitamin D partly prevented the observed bone loss. This finding emphasizes the importance of nutritional support strategies after bariatric surgery, but also affirms that the exact mechanisms leading to bone loss after bariatric surgery remain elusive and thus warrant further research.

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Fig. 1: BW, activity, and bone parameters after sham, SG, and RYGB.
Fig. 2: Serum PTH, food intake, calcium intake, intestinal absorption, and gene expression analysis 2 and 8 weeks after surgery.
Fig. 3: Renal calcium excretion and gene expression analysis 2 and 8 weeks after surgery.
Fig. 4: Bone parameters after sham, SG, and RYGB with calcium citrate and vitamin D supplementation.
Fig. 5: Intestinal absorption and gene expression analysis 8 weeks after surgery on calcium citrate and vitamin D fortified diets.
Fig. 6: Renal calcium excretion and gene expression analysis 8 weeks after surgery on calcium and vitamin D fortified diets.
Fig. 7: Overview of changes in bones, intestines, and kidneys after SG and RYGB.

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Acknowledgements

The authors would like to thank K. Moermans and R. Van Looveren for their histological preparation of bone samples and G. Molenberghs from the Interuniversity Institute for Biostatistics and Statistical Bioinformatics for his assistance with statistical analyses. This work was supported by the FWO (Flemish Research Council) grant numbers 1S27317N and 1802714N. The authors do not have any conflicts of interest to disclose.

Funding

This work was supported by the FWO (Flemish Research Council) [grant numbers 1S27317N and 1802714 N]. Bart Van der Schueren is a clinical researcher of FWO (Flemish Research Council).

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Authors and Affiliations

  1. Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing (CHROMETA), KU Leuven, Leuven, Belgium

    Katrien Corbeels, Lieve Verlinden, Matthias Lannoo, Rougin Khalil, Ann Mertens, Christophe Matthys, Annemieke Verstuyf, Ann Meulemans, Roman Vangoitsenhoven, Geert Carmeliet & Bart Van der Schueren

  2. Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium

    Matthias Lannoo & Ellen Deleus

  3. Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium

    Ann Mertens, Christophe Matthys, Ann Meulemans, Roman Vangoitsenhoven & Bart Van der Schueren

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Corbeels, K., Verlinden, L., Lannoo, M. et al. The curious fate of bone following bariatric surgery: bone effects of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in mice. Int J Obes 44, 2165–2176 (2020). https://doi.org/10.1038/s41366-020-0626-3

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