Effects of Biliopancreatic Diversion on Bone Turnover Markers and Association with Hormonal Factors in Patients with Severe Obesity

Obes Surg. 2019 Mar;29(3):990-998. doi: 10.1007/s11695-018-3617-x.

Abstract

Background: This study evaluated early and medium-term changes in bone turnover markers, and their associations with weight loss, total bone mineral density (BMD), and hormonal changes after biliopancreatic diversion (BPD).

Methods: Ancillary study from a one-year prospective cohort of 16 individuals assessed before, 3 days, 3 and 12 months after BPD. Bone turnover markers (C-terminal telopeptide (CTX), intact osteocalcin (OC), sclerostin, and osteoprotegerin (OPG)) and several hormones were measured at each visit. Total BMD by DXA was assessed at baseline, 3 and 12 months after BPD. Three participants were lost to follow-up.

Results: CTX increased significantly at 3 days (+ 66%), 3 months (+ 219%), and 12 months (+ 295%). OC decreased at 3 days (- 19%) then increased at 3 months (+ 69%) and 12 months (+ 164%). Change in sclerostin was only significant between 3 days and 3 months (+ 13%), while change in OPG was significant between baseline and 3 days (+ 48%) and baseline and 12 months (+ 45%). CTX increase correlated negatively with weight loss at 3 (r = - 0.63, p = 0.009) and 12 months (r = - 0.58, p = 0.039), and total BMD decrease (r = - 0.67, p = 0.033) at 12 months. Change in insulin and adiponectin correlated with changes in bone turnover markers independently of weight loss.

Conclusion: BPD causes an earlier and greater increase in bone resorption over bone formation markers and a decrease in total BMD. Sclerostin did not increase as expected following extensive weight loss. Changes in insulin and adiponectin seem to play a role in the activation of bone remodeling after BPD.

Keywords: Bariatric surgery; Biliopancreatic diversion; Biochemical markers of bone turnover; Bone mineral density; Hormones.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adiponectin / blood
  • Adult
  • Aged
  • Biliopancreatic Diversion* / methods
  • Biomarkers / analysis
  • Biomarkers / blood*
  • Bone Density / physiology
  • Bone Remodeling / physiology*
  • Cohort Studies
  • Female
  • Hormones / analysis
  • Hormones / blood*
  • Humans
  • Male
  • Middle Aged
  • Obesity, Morbid / blood
  • Obesity, Morbid / surgery*
  • Osteocalcin / blood
  • Osteoprotegerin / blood
  • Weight Loss / physiology
  • Young Adult

Substances

  • ADIPOQ protein, human
  • Adiponectin
  • Biomarkers
  • Hormones
  • Osteoprotegerin
  • TNFRSF11B protein, human
  • Osteocalcin

Grants and funding