Adverse Effects of Weight-Loss Surgery on Bone Health in Teens and Young Adults

by Manuel Costa
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A recent study published in Radiology has shed light on the detrimental impact of sleeve gastrectomy, a popular weight-loss surgery, on the bone health of adolescents and young adults who are obese.

The research findings indicate that sleeve gastrectomy, a commonly performed weight-loss surgery, negatively affects bone health among adolescents and young adults. Despite significant reductions in BMI observed two years post-surgery, the study revealed an increase in bone marrow fat and a decline in bone density and strength. This highlights the importance of post-surgery monitoring and management of bone health, potentially leading to the development of innovative therapies.

According to a study published in Radiology, a journal of the Radiological Society of North America (RSNA), weight-loss surgery commonly used for obese adolescents and young adults has been found to have detrimental effects on their bone health.

Dr. Miriam A. Bredella, the lead investigator of the study and a professor of radiology at Harvard Medical School, explained, “Childhood obesity is a growing concern, and weight-loss surgery is the most effective method to reduce weight and improve associated health conditions.” Dr. Bredella emphasized that their study was the first to investigate the long-term effects of sleeve gastrectomy, the most prevalent weight-loss surgery, on bone strength and bone marrow fat in adolescents and young adults.

Sleeve gastrectomy involves removing a substantial portion (approximately 75% to 80%) of the stomach to restrict food intake and facilitate weight loss. As a result, the stomach takes on a tube-like or sleeve shape. The American Society for Metabolic and Bariatric Surgery reports a significant increase in the number of sleeve gastrectomy procedures performed annually, surpassing gastric bypass as the primary weight-loss surgery, with over 122,000 surgeries conducted in 2020.

The study enrolled participants aged 13 to 24 years between 2015 and 2020, including adolescents and young adults with moderate to severe obesity. The young adults had a body mass index (BMI) of 35 or higher, while the adolescents were at 120% of the 95th age- and sex-specific percentile, indicating obesity. Out of the 54 participants, 25 underwent sleeve gastrectomy, while 29 were part of the control group, which received dietary and exercise counseling but did not plan to undergo the surgery.

The researchers conducted physical examinations, blood tests, and quantitative CT scans of the lumbar spine before and 24 months after sleeve gastrectomy to assess volumetric bone mineral density and perform finite element analysis to estimate bone strength. Additionally, proton MR spectroscopy was utilized to measure bone marrow fat in the lumbar spine, as it serves as a biomarker for bone quality.

After two years, the adolescents and young adults who underwent sleeve gastrectomy experienced a significant drop in BMI (on average, -11.9), while the control group showed a slight increase (on average, +1.5). Compared to the control group, those who underwent sleeve gastrectomy exhibited a notable increase in bone marrow fat and a decrease in bone density and strength in the lumbar spine.

Dr. Bredella highlighted the critical importance of bone mass development during adolescence and its potential long-term impact on bone health and fracture risk later in life. She stressed the need to raise awareness about the effects of weight-loss surgery on bone health in adolescents with obesity, particularly among healthcare providers responsible for their ongoing care. This awareness can lead to effective monitoring and management of low bone mass, adequate dietary supplementation with vitamin D and calcium, and timely initiation of appropriate therapies, if necessary.

Moreover, the observed effects of weight-loss surgery on bone strength and bone marrow fat could potentially serve as targets for novel therapeutic approaches.

The study titled “Two-year Skeletal Effects of Sleeve Gastrectomy in Adolescents with Obesity Assessed with Quantitative CT and MR Spectroscopy” was authored by Florian A. Huber, Vibha Singhal, Shubhangi Tuli, Imen Becetti, Ana Paola López López, Mary L. Bouxsein, Madhusmita Misra, and Miriam A. Bredella, and was published in Radiology on June 13, 2023.

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