Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers

Authors: WASSERMAN, HALLEY - University Of Cincinnati College Of Medicine; JENKINS, TODD - University Of Cincinnati College Of Medicine; INGE, THOMAS - Northwestern University; RYDER, JUSTIN - Northwestern University; MICHALSKY, MARC - Nationwide Children'S Hospital; SISLEY, STEPHANIE - Children'S Nutrition Research Center (CNRC); XIE, CHANGCHUN - University Of Cincinnati College Of Medicine; KALKWARF, HEIDI - University Of Cincinnati College Of Medicine

Submitted to: International Journal of Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/14/2023
Publication Date: 1/4/2024
Citation: Wasserman, H., Jenkins, T., Inge, T., Ryder, J., Michalsky, M., Sisley, S., Xie, C., Kalkwarf, H.J. 2024. Bone mineral density in young adults 5 to 11 years after adolescent metabolic and bariatric surgery for severe obesity compared to peers. International Journal of Obesity. 48:575-583. https://doi.org/10.1038/s41366-023-01453-8.
DOI: https://doi.org/10.1038/s41366-023-01453-8

Interpretive Summary: Weight loss after bariatric surgery can promote many beneficial outcomes, but whether it can lead to problems in bone health if performed in adolescents is unknown. Researchers in Houston, Texas studied bone health in young adults who had weight loss surgery as teenagers. Young adults who had weight loss surgery had lower bone density, especially in the hip and upper leg areas, than their peers who did not have surgery. Those who had surgery longer ago tended to have lower bone density scores in the hip and femur. However, how much weight they lost did not seem to affect their bone density years later. Doctors need to monitor bone health carefully in teens after weight loss surgery. This work enables better bone health management after adolescent weight loss surgery by raising awareness of long-term impacts in bone health.

Technical Abstract: Metabolic and bariatric surgery (MBS) is associated with decreased bone mineral density (BMD) in adults. The long-term impact of MBS during adolescence on BMD is unknown. We report bone health status 5 to 11 years after Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) from the Teen-LABS study cohort. Between 2016 and 2022, BMD was measured by dual energy x-ray bsorptiometry (DXA) in 106 young adults who had undergone MBS as adolescents. Volumetric BMD by peripheral quantitative computed tomography was measured on a subset. Ninety-one controls who had not undergone MBS were recruited for comparison. In cases (RYGB: mean age 26.8 =/- 1.9 years, mean BMI 42.1 +/- 9.9 kg/m2, VSG: mean age 25.1 +/- 2.1 years, mean BMI 37.1 +/- 8.4 kg/m2), compared to controls (mean age 26.5 +/- 2.7 years, mean BMI 40.2 +/- 8.7 kg/m2) (age p < 0.001, BMI p = 0.02), adjusted mean DXA-BMD (g/cm2) of the RYGB (n = 58) and VSG (n = 48) groups were lower at the hip (-10.0% and -6.3%), femoral neck (-9.6% and -5.7%) and ultra-distal radius (-7.9% and -7.0%; all p < 0.001), respectively. DXA-BMD did not differ between RYGB and VSG groups. Trabecular volumetric BMD at the radius and tibia were lower in the RYGB (-30% and -26%) and VSG(-15% and -14%) groups compared to the control group (p < 0.001). Greater time since MBS was associated with lower BMD Z-scores at the hip (p = 0.05) and femoral neck (p = 0.045). Percent change in body mass index (BMI) from baseline or in the first year after MBS were not associated with bone measures at a median of 9.3 years post MBS. BMD, especially of the hip and femoral neck, was lower in young adults who underwent MBS during adolescence compared to matched peers who had not undergone MBS. BMD Z-scores of the femoral neck were inversely associated with time since MBS but were not associated with BMI change.