Screen Gastric Bypass Patients Due to Bone Effects?

A recent study from the University of California, San Francisco has resulted in new suggestions for clinicians working with bypass patients who are postmenopausal.

Their work, “Effects of Gastric Bypass Surgery on Bone Mass and Microarchitecture Occur Early and Particularly Impact Postmenopausal Women,” was published in the June 2018 edition of the Journal of Bone and Mineral Research.

The authors wrote, “Roux‐en‐Y gastric bypass (RYGB) surgery is a highly effective treatment for obesity but negatively affects the skeleton. Studies of skeletal effects have generally examined areal bone mineral density (BMD) by dual‐energy X‐ray absorptiometry (DXA), but DXA may be inaccurate in the setting of marked weight loss.”

“Further, as a result of modestly sized samples of mostly premenopausal women and very few men, effects of RYGB by sex and menopausal status are unknown. We prospectively studied the effects of RYGB on skeletal health, including axial and appendicular volumetric BMD and appendicular bone microarchitecture and estimated strength.”

“Obese adults (N = 48; 27 premenopausal and 11 postmenopausal women, 10 men) with mean ± SD body mass index (BMI) 44 ± 7 kg/m² were assessed before and 6 and 12 months after RYGB. Participants underwent spine and hip DXA, spine QCT, radius and tibia HR‐pQCT, and laboratory evaluation.”

Anne Schafer, M.D., an associate professor of Medicine and of Epidemiology and Biostatistics University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, told OTW, “If the negative skeletal effects of Roux-en-Y gastric bypass surgery are better understood, we will be better prepared to address them. In this study, we learned that the negative skeletal effects occur early, and that they particularly impact postmenopausal women. Thus, it may be appropriate to target postmenopausal women undergoing gastric bypass with screening and preventive or therapeutic interventions.”