Scientists Discover That Common Weight-Loss Surgery Weakens Bones

A current research highlights the detrimental results on bone strength and bone marrow fats in adolescents and younger adults who bear sleeve gastrectomy, a typical weight-loss surgical procedure. The analysis emphasizes the importance of understanding these implications, particularly throughout the essential bone-building adolescent years, to make sure correct medical care and monitoring post-surgery.

A research revealed in Radiology, the journal of the Radiological Society of North America (RSNA), has revealed {that a} frequent weight-loss surgical procedure for chubby adolescents and younger adults could have hostile impacts on bone health.

“Childhood obesity is on the rise and weight-loss surgery is the most effective way to reduce weight and improve cardiometabolic comorbidities,” mentioned the research’s lead investigator, Miriam A. Bredella, M.D., professor of radiology at Harvard Medical School in Boston, Massachusetts, and vice chair for Faculty Affairs and Clinical Operations, Department of Radiology Massachusetts General Hospital in Boston. “This is the first study in adolescents and young adults that examined the long-term effects of sleeve gastrectomy, the most common type of weight-loss surgery, on bone strength and bone marrow fat.”

Sleeve gastrectomy removes roughly 75% to 80% of the abdomen to limit food consumption and induce weight loss. It leads to a usually spherical abdomen taking up the form of a tube or sleeve. The estimated variety of sleeve gastrectomy procedures carried out annually elevated from over 28,000 surgical procedures in 2011 to over 122,000 in 2020, based on the American Society for Metabolic and Bariatric Surgery. Sleeve gastrectomy has overtaken gastric bypass as the first weight-loss operation.

For the research, contributors between the age of 13 and 24 years had been enrolled from 2015 to 2020. The adolescents and younger adults had average to extreme weight problems. The younger adults had a body max index (BMI) of 35 or above. A BMI of 30 or above is taken into account overweight. Adolescent contributors had been at 120% of the 95th age- and sex-specific percentile.

There had been 54 contributors, 25 who underwent sleeve gastrectomy and 29 who had been within the management group. Forty-one research contributors had been feminine. The surgical group included contributors with a minimum of one obesity-related co-morbidity or a BMI at or above 40. The management group had weight problems however didn’t plan to bear sleeve gastrectomy however acquired dietary and exercise counseling.

Weight Loss Surgery Weakens Bones of Teens and Young Adults

Biomechanical non-contrast CT evaluation of the L1 vertebra in an 18-year-old lady with extreme weight problems (body mass index [BMI], 48.4 kg/m2) previous to sleeve gastrectomy (SG) and 24 months after surgical procedure (BMI, 26.6 kg/m2). L1 vertebra was loaded to 9820 N at each visits for comparability functions. Breaking strength was (A) 11 920 N at baseline previous to SG and (B) 9820 N at 24 months after surgical procedure. Cutout views of the finite factor fashions beneath compressive load depict the distribution of bone mineral density (black and white areas) and bone failure (coloured areas). Red signifies tissue that failed earlier throughout the compressive load (weaker bone). Shades of grey point out completely different bone densities, with white being dense bone and black being little or no bone mineral. Credit: Radiological Society of North America

Before and 24 months after sleeve gastrectomy, contributors underwent a bodily examination, blood assessments, and quantitative CT of the lumbar backbone, to quantify volumetric bone mineral density and to carry out finite factor evaluation, a method that may estimate bone strength. Quantitative CT is a extremely correct method for detecting modifications in volumetric bone mineral density after excessive weight loss.

Studies have proven that bone marrow fats responds to modifications in nutrition and will function a biomarker for bone high quality. Therefore, sufferers underwent proton MR spectroscopy to quantify bone marrow fats of the lumbar backbone.

Two years following surgical procedure, BMI within the adolescents and younger adults dropped (-11.9, on common), whereas there was a slight rise in BMI within the management group (+1.5, on common). Compared to the controls, sleeve gastrectomy sufferers had a big improve in bone marrow fats and a lower in bone density and strength estimates within the lumbar backbone.

“We found that bone strength was lower two years after weight-loss surgery, while bone marrow fat, a marker of bone weakening, was increased, suggesting that weight-loss surgery has negative effects on bone health,” Dr. Bredella mentioned.

Dr. Bredella factors out that the adolescent years are a important time for building up bone mass, and deficits in bone accrual throughout these years might have a long-term influence on bone health and fracture danger on this youthful inhabitants later in life.

“As bariatric surgery is increasingly performed in adolescents, its effect on bone health needs to be emphasized, especially to the physicians who will continue to provide routine medical care for these patients,” Dr. Bredella mentioned. “We hope that our study will raise awareness on the effects of weight-loss surgery on bones in adolescents with obesity.”

Raising consciousness of the significance of bone health will permit for monitoring and administration of low bone mass, optimum dietary supplementation with vitamin D and calcium, and the initiation of applicable remedy, if vital, Dr. Bredella famous.

“Our observed effects of weight-loss surgery on bone strength and bone marrow fat might also identify new targets for novel therapies,” she mentioned.

Reference: “Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy” by Florian A. Huber, Vibha Singhal, Shubhangi Tuli, Imen Becetti, Ana Paola López López, Mary L. Bouxsein, Madhusmita Misra and Miriam A. Bredella, 13 June 2023, Radiology.
DOI: 10.1148/radiol.223256

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