Vertical sleeve gastrectomy increases skeletal fragility in youth, says JCEM study

USA: A study published in The Journal of Clinical Endocrinology & Metabolism has concluded that Vertical Sleeve Gastrectomy (VSG) causes progressive changes in bone health and is associated with increased skeletal fragility in adolescents and young adults.

Obesity is a growing public health concern worldwide. A prediction mentioned that in 2025, 18% of men and 21% of women would be "obese".

Obesity is an epidemic, and intending to achieve long-term weight loss, bariatric surgeries are on the rise. On the one hand, these surgeries have a positive association with the improvement and resolution of comorbidities, but on the other, it has adverse effects on bone health.

The Roux‐en‐Y gastric bypass (RYGB) procedure is the most commonly performed bariatric procedure and is recently overtaken by sleeve gastrectomy (SG).

SG, a newer procedure, has incomplete data related to its skeletal effects.

The skeletal effects of bariatric surgery are presumably multifactorial, and mechanisms may involve Nutritional factors, mechanical unloading, hormones, body composition changes, and bone marrow fat, these are some of the factors behind the multifactorial mechanism of skeletal effects in bariatric surgeries.

Clinical guidelines addressing bone health may eliminate the adverse skeletal effects of surgery. But this requires more research and data to support these guidelines.

VSG is a surgical procedure or a tool that assists in weight loss. The use of this tool is becoming popular and common for achieving weight loss. In this, The surgeon removes a large portion of your stomach.

VSG aids in the achievement of weight loss and also improves metabolic health in adolescents and young adults with obesity. But it has side effects too. It affects bone health adversely.

Considering the above background, a study was conducted by Dr Deborah M Mitchell and the team from the Division of Pediatric Endocrinology at Massachusetts General Hospital and Harvard Medical School to evaluate " What are the effects of VSG on bone health in youth?"

The critical points of the study are:

• The study period was of 2 years. This observational study was conducted at a tertiary care centre.

• The study included 66 patients aged 13 to 24 years.

• The patients met moderate-to-severe obesity meeting criteria for VSG.

• A total of 30 patients underwent VSG.

• A total of 36 patients underwent nonsurgical management.

• The patient and clinical team decided the type of management.

• The dual-energy x-ray absorptiometry (DXA) and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of bone mineral density (BMD), geometry, and microarchitecture were the main outcome measures.

• The weight loss achieved in VSG patients was 25.3 ± 2.0% at two years with a P value of < 0.001.

• The weight gained in the control subjects was 4.0 ± 2.0%, and the P value of 0.026.

• Following VSG, the total hip BMD declined to 8.5 ± 1.0% while it was 0.1 ± 1.0% gain in controls. The P value was <0 .001. Similar results were obtained at the femoral neck with a P value of < 0.001.

• After VSG, the Total volumetric BMD (vBMD) was decreased at the distal radius and tibia, both with a P value of < 0.001. This was driven primarily by trabecular vBMD loss, with a P value of < 0.001.

• There was no difference between the two groups for two-year changes in cortical vBMD.

• The cortical porosity decreased after VSG with a P value of 0.048 and P<0.001 at the radius and tibia.

• Cortical thickness increased in controls and not in VSG with P = .022 and P = .002 for between-group comparisons at the radius and tibia.

• After VSG, the estimated failure load decreased at the radius and did not demonstrate the physiologic increases at the tibia observed in controls.

The authors finally concluded that VSG has an adverse effect on bone. It leads to progressive changes in bone health over two years. VSG is associated with increased skeletal fragility in adolescents and young adults, they said.

Further reading:

Deborah M Mitchell, Vibha Singhal, Abisayo Animashaun, Amita Bose, Brian Carmine, Fatima C Stanford, Thomas H Inge, Megan M Kelsey, Hang Lee, Mary L Bouxsein, Elaine W Yu, Miriam A Bredella, Madhusmita Misra, Skeletal Effects of Sleeve Gastrectomy in Adolescents and Young Adults: A 2-Year Longitudinal Study, The Journal of Clinical Endocrinology & Metabolism, 2022; dgac634