Aumento de niveles de PTH y de 1.25(OH)(2)D asociados con un incremento de los marcadores de recambio óseo después de cirugía bariátrica
Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery.
Sinha N, Shieh A, Stein EM, Strain G, Schulman A, Pomp A, Gagner M, Dakin G, Christos P, Bockman RS.
Department of Medicine, Division of Medicine, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.sinhana@med.cornell.edu
Obesity (Silver Spring). 2011 Dec;19(12):2388-93
. doi: 10.1038/oby.2011.133. Epub 2011 May 26.
Abstract
The objective of this study was to characterize changes in metabolic bone parameters following bariatric surgery. Seventy-three obese adult patients who underwent either gastric banding (GB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS) were followed prospectively for 18 months postoperatively. Changes in the calcium-vitamin D axis (25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), calcium, parathyroid hormone (PTH)), markers of bone formation (osteocalcin, bone-specific alkaline phosphatase) and resorption (urinary N-telopeptide (NTx)), as well as bone mineral density (BMD) were assessed at 3-month intervals during this time period. Bariatric surgery resulted in significant and progressive weight loss over 18 months. With supplementation, 25OHD levels increased 65.3% (P < 0.0001) by 3 months, but leveled off and decreased <30 ng/ml by 18 months. PTH initially decreased 21.4% (P = 0.01) at 3 months, but later approached presurgery levels. 1,25(OH)(2)D increased significantly starting at month 12 (50.3% increase from baseline, P = 0.008), and was positively associated with PTH (r = 0.82, P = 0.0001). When stratified by surgery type, median PTH and 1,25(OH)(2)D levels were higher following combined restrictive and malabsorptive operations (RYGB and BPD/DS) compared to GB. Bone formation/resorption markers were increased by 3 months (P < 0.05) and remained elevated through 18 months. Radial BMD decreased 3.5% by month 18, but this change was not significant (P = 0.23). Our findings show that after transient improvement, preoperative vitamin D insufficiency and secondary hyperparathyroidism persisted following surgery despite supplementation. Postoperative secondary hyperparathyroidism was associated with increased 1,25(OH)(2)D levels and increased bone turnover markers.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411200/
pdf/nihms387898.pdf
Enfermedad ósea metabólica en pacientes de cirugía bariátrica
Metabolic bone disease in the bariatric surgery patient.
Williams SE.
Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue / G-10, Cleveland, OH 44195-0001, USA.
J Obes. 2011;2011:634614. Epub 2010 Dec 28.
Abstract
Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD) due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022191/pdf/JOBES2011-634614.pdf
Deficiencias nutricionales despues de bypass gástrico
Seeniann John, DO, MPH
Carl Hoegerl, DO, MSc
J Am Osteopath Assoc. 2009;109:601-604
Nutritional deficiencies are unrecognized in approximately 50% of patients who undergo gastric bypass surgery. The authors present some of the more common nutritional deficiencies and related complications that can occur in this patient population. Greater awareness of the potential effects of nutritional deficiency after gastric bypass surgery may help physicians better recognize and manage these challenging conditions.
http://www.jaoa.org/content/109/11/601.full.pdf+html
Pérdida ósea en adolescentes despues de cirugía bariátrica
Bone loss in adolescents after bariatric surgery.
Kaulfers AM, Bean JA, Inge TH, Dolan LM, Kalkwarf HJ.
Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. akaulfers@usouthal.edu
Pediatrics. 2011 Apr;127(4):e956-61. Epub 2011 Mar 28.
Abstract
OBJECTIVE:
To evaluate bone loss in adolescents after Roux-en-Y gastric bypass surgery and to determine the extent to which bone loss was related to weight loss. We hypothesized that adolescents would lose bone mass after surgery and that it would be associated with weight loss. PATIENTS AND METHODS: We conducted a retrospective case review of 61 adolescents after bariatric surgery. Whole-body bone mineral content (BMC) and density (BMD) were measured by dual-energy radiograph absorptiometry, and age- and gender-specific BMD z scores were calculated. Measurements were obtained when possible before surgery and then every 3 to months after surgery for up to 2 years. Data were analyzed by using a mixed-models approach, and regression models were adjusted for age, gender, and height. RESULTS: Whole-body BMC, BMD z score, and weight decreased significantly over time after surgery (P < .0001 for all). In the first 2 years after surgery, predicted values on the basis of regression modeling for BMC decreased by 7.4%, and BMD z score decreased from 1.5 to 0.1. During the first 12 months after surgery, change in weight was correlated with change in BMC (r = 0.31; P = .02). Weight loss accounted for 14% of the decrease in BMC in the first year after surgery. CONCLUSION: Bariatric surgery is associated with significant bone loss in adolescents. Although the predicted bone density was appropriate for age 2 years after surgery, longer follow-up is warranted to determine whether bone mass continues to change or stabilizes.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065081/pdf/zpee956.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Increased PTH and 1.25(OH)(2)D levels associated with increased markers of bone turnover following bariatric surgery.
Sinha N, Shieh A, Stein EM, Strain G, Schulman A, Pomp A, Gagner M, Dakin G, Christos P, Bockman RS.
Department of Medicine, Division of Medicine, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA.sinhana@med.cornell.edu
Obesity (Silver Spring). 2011 Dec;19(12):2388-93
. doi: 10.1038/oby.2011.133. Epub 2011 May 26.
Abstract
The objective of this study was to characterize changes in metabolic bone parameters following bariatric surgery. Seventy-three obese adult patients who underwent either gastric banding (GB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion with duodenal switch (BPD/DS) were followed prospectively for 18 months postoperatively. Changes in the calcium-vitamin D axis (25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D (1,25(OH)(2)D), calcium, parathyroid hormone (PTH)), markers of bone formation (osteocalcin, bone-specific alkaline phosphatase) and resorption (urinary N-telopeptide (NTx)), as well as bone mineral density (BMD) were assessed at 3-month intervals during this time period. Bariatric surgery resulted in significant and progressive weight loss over 18 months. With supplementation, 25OHD levels increased 65.3% (P < 0.0001) by 3 months, but leveled off and decreased <30 ng/ml by 18 months. PTH initially decreased 21.4% (P = 0.01) at 3 months, but later approached presurgery levels. 1,25(OH)(2)D increased significantly starting at month 12 (50.3% increase from baseline, P = 0.008), and was positively associated with PTH (r = 0.82, P = 0.0001). When stratified by surgery type, median PTH and 1,25(OH)(2)D levels were higher following combined restrictive and malabsorptive operations (RYGB and BPD/DS) compared to GB. Bone formation/resorption markers were increased by 3 months (P < 0.05) and remained elevated through 18 months. Radial BMD decreased 3.5% by month 18, but this change was not significant (P = 0.23). Our findings show that after transient improvement, preoperative vitamin D insufficiency and secondary hyperparathyroidism persisted following surgery despite supplementation. Postoperative secondary hyperparathyroidism was associated with increased 1,25(OH)(2)D levels and increased bone turnover markers.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411200/
pdf/nihms387898.pdf
Enfermedad ósea metabólica en pacientes de cirugía bariátrica
Metabolic bone disease in the bariatric surgery patient.
Williams SE.
Department of Internal Medicine, Cleveland Clinic, 9500 Euclid Avenue / G-10, Cleveland, OH 44195-0001, USA.
J Obes. 2011;2011:634614. Epub 2010 Dec 28.
Abstract
Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD) due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3022191/pdf/JOBES2011-634614.pdf
Deficiencias nutricionales despues de bypass gástrico
Seeniann John, DO, MPH
Carl Hoegerl, DO, MSc
J Am Osteopath Assoc. 2009;109:601-604
Nutritional deficiencies are unrecognized in approximately 50% of patients who undergo gastric bypass surgery. The authors present some of the more common nutritional deficiencies and related complications that can occur in this patient population. Greater awareness of the potential effects of nutritional deficiency after gastric bypass surgery may help physicians better recognize and manage these challenging conditions.
http://www.jaoa.org/content/109/11/601.full.pdf+html
Pérdida ósea en adolescentes despues de cirugía bariátrica
Bone loss in adolescents after bariatric surgery.
Kaulfers AM, Bean JA, Inge TH, Dolan LM, Kalkwarf HJ.
Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA. akaulfers@usouthal.edu
Pediatrics. 2011 Apr;127(4):e956-61. Epub 2011 Mar 28.
Abstract
OBJECTIVE:
To evaluate bone loss in adolescents after Roux-en-Y gastric bypass surgery and to determine the extent to which bone loss was related to weight loss. We hypothesized that adolescents would lose bone mass after surgery and that it would be associated with weight loss. PATIENTS AND METHODS: We conducted a retrospective case review of 61 adolescents after bariatric surgery. Whole-body bone mineral content (BMC) and density (BMD) were measured by dual-energy radiograph absorptiometry, and age- and gender-specific BMD z scores were calculated. Measurements were obtained when possible before surgery and then every 3 to months after surgery for up to 2 years. Data were analyzed by using a mixed-models approach, and regression models were adjusted for age, gender, and height. RESULTS: Whole-body BMC, BMD z score, and weight decreased significantly over time after surgery (P < .0001 for all). In the first 2 years after surgery, predicted values on the basis of regression modeling for BMC decreased by 7.4%, and BMD z score decreased from 1.5 to 0.1. During the first 12 months after surgery, change in weight was correlated with change in BMC (r = 0.31; P = .02). Weight loss accounted for 14% of the decrease in BMC in the first year after surgery. CONCLUSION: Bariatric surgery is associated with significant bone loss in adolescents. Although the predicted bone density was appropriate for age 2 years after surgery, longer follow-up is warranted to determine whether bone mass continues to change or stabilizes.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3065081/pdf/zpee956.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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