Re: Kids Lose Bone After Bariatric Surgery

[Guest guest]

Not only adolescents loose bone mass, also adults in most of bariatric gastric

surgery procedures. Vitamin D and calcium supplementation is recommended.

Cátia Borges

>

> Obese adolescents lost significant amounts of bone mineral content during

> the first two years after bariatric surgery, results of a retrospective case

> review showed.

>

> Bone mineral content decreased by 7.4% during the period reviewed. Weight,

> bone mineral content, and bone mineral density (BMD) z score all declined

> significantly after surgery (*P*<0.0001). However, the z score remained

> above average.

>

> Correlation analysis showed a significant association between weight loss

> and change in bone mineral content (*P*=0.02), Anne-Marie D. Kaulfers, MD,

> of Cincinnati Children's Hospital Medical Center, and colleagues reported

> online in *Pediatrics*.

>

> " Although the predicted bone density was appropriate for age two years after

> surgery, longer follow-up is warranted to determine whether bone mass

> continues to change or stabilizes, " they wrote in conclusion.

>

> Mirroring the trend in adults, obesity in adolescents has increased over the

> past decade, affecting an estimated 18.1% of children (*JAMA * 2010; 303:

> 242-249). The ineffectiveness of behavior modification has led a growing

> number of adolescents to bariatric

> surgery<http://www.medpagetoday.com/MeetingCoverage/ASMBS/20903>to

> achieve weight loss.

>

> Among bariatric options, Roux-en-Y gastric bypass has achieved dramatic

> weight loss in adolescents, averaging 58% to 73% during the first year after

> surgery, Kaulfers and co-authors wrote. However, the long-term consequences

> of the surgery in children and adolescents remain unclear.

>

> Loss of bone mineral at a time when young people should be reaching peak

> bone mass could put future bone health at risk, they continued.

>

> To explore the issue, Kaulfers and colleagues reviewed medical records of

> 102 young patients who had laparoscopic Roux-en-Y gastric bypass surgery

> from 2001 to 2008. To be considered for the surgery, patients had to meet

> five criteria:

>

> - Unsuccessful weight-loss attempts lasting more than six months

> - Body mass index (BMI) >35

> - One or more obesity-related comorbidities

> - Completion of all or most linear growth

> - Acceptable psychologic evaluation

>

> Patients underwent dual x-ray absorptiometry (DXA) before surgery and then

> every three to six months afterward for two years. For each patient,

> investigators calculated whole-body bone mineral content and BMD z score.

>

> The final analysis included 61 patients, 51 of whom were female and whose

> age averaged 17. The primary reason for exclusion was a baseline weight that

> exceeded the limits of the densitometry machine.

>

> Preoperative BMI averaged 54 to 55, weight averaged 335 pounds among girls

> and 367 pounds in boys, and height averaged 65.9 inches in girls and 68.6

> inches in boys.

>

> Baseline characteristics included nonalcoholic fatty liver disease in 18%,

> hypertension in 30%, depression in 33%, sleep apnea in 63%, type 2 diabetes

> in 11%, and polycystic ovary syndrome in 28% of the girls.

>

> On average the patients had three DXA scans during follow-up; all of the

> study participants had at least two scans. The last scan occurred an average

> of 13.9 months after surgery (range of 2.8 to 26.8 months).

>

> The predicted weight loss was 41.4 pounds at six months, 58.4 pounds at 12

> months, 61 pounds at 18 months, and 49.2 pounds at 24 months.

>

> The preoperative whole-body bone mineral content averaged 2,692 g,

> decreasing to 2,552 g after one year (5.2%) and to 2,494 g at two years

> (7.4%).

>

> Weight and bone mineral content declined in a curvilinear manner over time (

> *P*<0.0001), whereas BMD z score declined in a linear fashion (*P*<0.0001).

>

> The patients' mean BMD z score decreased from 1.5 at baseline to 0.1 over

> the two-year follow-up period, BMD z score remained above average for the

> cohort.

>

> In contrast to bone mineral content, BMD z score did not correlate

> significantly with weight change (*P*=0.73).

>

> " It is reassuring that these patients began with greater BMD z score than

> expected, and BMD did not typically fall below average during the two years

> after surgery, " the authors wrote in their discussion.

>

> " However, the clinical consequences of losing bone mass after Roux-en-Y

> gastric bypass performed in the adolescent years are unknown. Therefore,

> these adolescents need to be followed long-term to determine if the decrease

> in BMD z score continues and increases their risk for future fractures.

>

LINK<http://www.medpagetoday.com/Pediatrics/Obesity/25556?utm_content= & utm_mediu\

m=email & utm_campaign=DailyHeadlines & utm_source=WC & em=nro1@...>

>

> *Primary source: *Pediatrics

> Source reference:

> Kaulfers AD " Bone loss in adolescents after bariatric surgery "

> *Pediatrics*2011; DOI:10.1542/peds.2010-0785.

>

>

>

> --

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