Biomechanical CT to assess bone after sleeve gastrectomy in adolescents with obesity:​ a prospective longitudinal study

Huber, Florian A.<sup>1,2</sup>; Singhal, Vibha<sup>3,4,5</sup>; Tuli, Shubhangi<sup>3</sup>; Stanford, Fatima C.<sup>3,4,5</sup>; Carmine, Brian<sup>6</sup>; Bouxsein, Mary L.<sup>7</sup>; Misra, Madhusmita<sup>3,4</sup>; Bredella, Miriam A.<sup>1</sup>

Affiliations

¹Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

²Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland

³Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

⁴Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

⁵Massachusetts General Hospital, Boston, MA, USA

⁶Department of Surgery, Boston University Medical Center, Boston, MA, USA

⁷Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Abstract and keywords

Sleeve gastrectomy (SG) is effective in treating cardiometabolic complications of obesity but is associated with bone loss. Our aim was to determine the effect of SG on the lumbar spine by biomechanical CT analysis in adolescents/young adults with obesity. We hypothesized that SG would lead to a decrease in strength and bone mineral density (BMD) compared with nonsurgical controls. In a 12-month prospective nonrandomized study, adolescents/young adults with obesity underwent SG (n = 29, 18.0 ± 2.1 years, 23 female) or were followed without surgery (controls, n = 30, 17.95 ± 3.0 years, 22 female). At baseline and 12 months, participants underwent quantitative computed tomography (QCT) of L₁ and L₂ for biomechanical assessment and MRI of the abdomen and mid-thigh for body composition assessment. Twelve-month changes between groups and within groups were assessed. Analyses were controlled for baseline and 12-month changes in body mass index (BMI) by multivariable analyses. Regression analysis was performed to evaluate the effect of body composition on bone parameters. Our institutional review board (IRB) approved the study, and informed consent/assent was obtained. Participants in the SG group had a higher baseline BMI than controls (p = 0.01) and lost an average of 34.3 ± 13.6 kg 12 months after surgery, whereas weight was unchanged in controls (p < 0.001). There were significant reductions in abdominal adipose tissue and thigh muscle area in the SG group compared with controls (p < 0.001). Bone strength, bending stiffness, and average and trabecular volumetric BMD decreased in the SG group compared with controls (p < 0.001). After controlling for change in BMI, a 12-month reduction in cortical BMD was significant in the SG group compared with controls (p = 0.02). Reductions in strength and trabecular BMD were associated with reductions in BMI, visceral adipose tissue, and muscle (p ≤ 0.03). In conclusion, SG in adolescents decreased strength and volumetric BMD of the lumbar spine compared with nonsurgical controls. These changes were associated with decreases in visceral fat and muscle mass.

Keywords: RADIOLOGY; ANALYSIS/QUANTITATION OF BONE; BONE QCT/MICROCT; CLINICAL TRIALS; ORTHOPEDICS; BIOMECHANICS; THERAPEUTICS

Links

DOI: 10.1002/jbmr.4784

PubMed: 37073493

WoS: 000974904800001

History

Received: 2022-11-10

Revised: 2023-01-28

Accepted: 2023-02-01

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Cited By (1)

Year	Entry
2023	Hornick MA, Van Name M. Decreased bone density and strength in young people after bariatric surgery: how much matters? J Bone Miner Res. 2023;38(7):931-932.