Bone mineral density after bariatric surgery. A systematic review.

Area of Science:

• Endocrinology
• Orthopedics
• Metabolic Surgery

Background:

• Bariatric surgery significantly impacts bone metabolism.
• Bone mineral density (BMD) changes vary across different surgical procedures.
• Proactive measures to prevent bone loss are often overlooked until complications arise.

Purpose of the Study:

• To systematically review and compare BMD loss following various bariatric surgical procedures.
• To determine if BMD loss is comparable across different bariatric surgery types.

Main Methods:

• Systematic review and meta-analysis of studies involving morbidly obese adults undergoing bariatric surgery.
• BMD measurements using dual-energy X-ray absorptiometry (DXA) at baseline and post-surgery.
• Quality assessment using STROBE and Cochrane Risk of Bias tools; heterogeneity analysis using I² and Chi² statistics.

Main Results:

• Twelve studies were included, revealing significant total BMD reduction (-0.03 g/cm²) after one year in mixed procedures.
• Significant BMD reductions were observed in the hip (-0.12 g/cm²), spine (-0.07 g/cm²), and forearm (-0.03 g/cm²).
• No significant BMD reduction was noted after restrictive surgeries; however, studies exhibited high heterogeneity and low evidence quality.

Conclusions:

• Mixed bariatric surgeries are associated with significantly greater BMD deterioration compared to restrictive procedures.
• Increased clinical attention and preventative strategies are crucial to mitigate fracture risk in patients undergoing mixed bariatric surgery.