Bone Loss After Bariatric Surgery: Causes Consequences and Management

摘要

Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many co-morbidities. Among the side effects of these procedures are detrimental effects on bone and mineral metabolism. This review explores the skeletal response to bariatric surgery, potential mechanisms for these changes and strategies for management. Bone disease among bariatric surgery patients is influenced by pre-operative abnormalities in bone and mineral metabolism related to morbid obesity. Changes that occur after surgery are specific to procedure type, with the most pronounced abnormalities in calciotropic hormones and bone loss seen after procedures that result in the most malabsorption. The most consistent site for bone loss after all bariatric procedures is at the hip, although available BMD data are limited by issues associated with DXA technology, including artifact introduced by adipose tissue itself. The bone loss that occurs after bariatric surgery is likely multifactorial. Proposed mechanisms include skeletal unloading, abnormalities in calciotropic hormones, as well as changes in gut hormones. There are very limited data on fracture risk in the bariatric population, and this is a critical area for additional research. Current treatment should be geared toward correcting nutritional deficiencies and following BMD in high-risk patients.