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Bone Metabolism in Adolescents Undergoing Bariatric Surgery
Madhusmita Misra1,2, Miriam A Bredella3
1Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, Massachusetts.
The Journal of Clinical Endocrinology and Metabolism
|November 16, 2020
Summary
Metabolic and bariatric surgery (MBS) in adolescents is linked to bone density loss. Sleeve gastrectomy shows some cortical bone benefits but axial marrow fat increases, impacting bone health.
Area of Science:
- Pediatric Endocrinology
- Orthopedics
- Bariatric Surgery
Background:
- Childhood obesity rates have surged, leading to increased use of metabolic and bariatric surgery (MBS) in adolescents.
- While adult MBS is known to cause bone loss, its impact on the developing adolescent skeleton is less understood.
Purpose of the Study:
- To review current data on how common MBS procedures affect bone health in adolescents.
- To analyze the effects of sleeve gastrectomy and gastric bypass on adolescent bone.
Main Methods:
- A literature review was conducted using PubMed.
- English-language articles on MBS and adolescent bone health were analyzed.
Main Results:
- Metabolic and bariatric surgery (MBS) led to decreased areal bone mineral density (aBMD) and Z scores in adolescents.
- Sleeve gastrectomy showed increased cortical volumetric BMD (vBMD) but also increased axial marrow adipose tissue (MAT) and reduced peripheral bone strength.
- Weight loss and reduced lean/fat mass correlated with bone loss and microarchitectural changes.
Conclusions:
- MBS in adolescents is associated with reduced aBMD and increased axial MAT.
- Sleeve gastrectomy may increase peripheral cortical vBMD and decrease peripheral MAT, with no reported decrease in peripheral strength estimates.
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