Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Julian Bühler; Silvan Rast; Christoph Beglinger; Ralph Peterli; Thomas Peters; Martina Gebhart; Anne Christin Meyer-Gerspach; Bettina Karin Wölnerhanssen

doi:10.1159/000512450

Long-Term Effects of Laparoscopic Sleeve Gastrectomy and Roux-en-Y Gastric Bypass on Body Composition and Bone Mass Density

Obes Facts. 2021;14(1):131-140. doi: 10.1159/000512450. Epub 2020 Dec 17.

Authors

Julian Bühler^{1

2

3}, Silvan Rast^{1

2}, Christoph Beglinger², Ralph Peterli^{1

2

3}, Thomas Peters⁴, Martina Gebhart⁴, Anne Christin Meyer-Gerspach^{1

2}, Bettina Karin Wölnerhanssen^{5

6}

Affiliations

¹ St. Clara Research Ltd., St. Claraspital, Basel, Switzerland.
² University of Basel, Basel, Switzerland.
³ Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.
⁴ Endocrinology and Nutrition, St. Claraspital, Basel, Switzerland.
⁵ St. Clara Research Ltd., St. Claraspital, Basel, Switzerland, bettina.woelnerhanssen@unibas.ch.
⁶ University of Basel, Basel, Switzerland, bettina.woelnerhanssen@unibas.ch.

Abstract

Background: Currently, the two most common bariatric procedures are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB). Long-term data comparing the two interventions in terms of their effect on body composition and bone mass density (BMD) are scarce.

Objective: The aim of this study was to assess body composition and BMD at least 5 years after LSG and LRYGB.

Setting: Department of Endocrinology and Nutrition, St. Claraspital Basel and St. Clara Research Ltd., Basel, Switzerland.

Methods: Bariatric patients at least 5 years after surgery (LSG or LRYGB) were recruited, and body composition and BMD were measured by means of dual-energy X-ray absorptiometry. Data from body composition before surgery were included in the analysis. Blood samples were taken for determination of plasma calcium, parathyroid hormone, vitamin D3, alkaline phosphatase, and C-terminal telopeptide, and the individual risk for osteoporotic fracture assessed by the Fracture Risk Assessment Tool score was calculated. After surgery, all patients received multivitamins, vitamin D3, and zinc. In addition, LRYGB patients were prescribed calcium.

Results: A total of 142 patients were included, 72 LSG and 70 LRYGB, before surgery: median body mass index 43.1, median age 45.5 years, 62.7% females. Follow-up after a median of 6.7 years. For LRYGB, the percentage total weight loss at follow-up was 26.3% and for LSG 24.1% (p = 0.243). LRYGB led to a slightly lower fat percentage in body composition. At follow-up, 45% of both groups had a T score at the femoral neck below -1, indicating osteopenia. No clinically relevant difference in BMD was found between the groups.

Conclusions: At 6.7 years after surgery, no difference in body composition and BMD between LRYGB and LSG was found. Deficiencies and bone loss remain an issue after both interventions and should be monitored.

Keywords: Bariatric surgery; Body composition; Bone density; Dual-energy X-ray absorptiometry; Gastric bypass; Sleeve gastrectomy.

MeSH terms

Absorptiometry, Photon
Adult
Body Composition
Body Mass Index
Female
Gastrectomy* / methods
Gastric Bypass* / methods
Humans
Laparoscopy / methods
Male
Middle Aged
Obesity, Morbid / surgery
Switzerland
Weight Loss