Bones may weaken after weight loss surgery - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

Phoenixfire · 03-18-2009, 01:15 AM

From a recent physical, which led to a bone density scan because I'm 40, I learned I need medication because of a loss of bone density. I worried about this, and my fears have been realized. Ugh.

Anyway, since then I've done some research to find studies. Here is a recent study, with its findings, below (the website is linked at the bottom).

Hopefully everyone who has WLS will get annual bone density scans after surgery. They're NOT just for us older folks. But if you're older you're looking at other contributing issues.

The condition of our bones after WLS, and their density, looks like something EVERYONE should monitor, based on studies including just this one:

NEW YORK (Reuters Health) - Patients lose bone density after weight loss surgery, and the more weight they lose, the greater the drop, new research shows.

While the effect of bone density loss on future fracture risk is not yet clear, "for the present, a high degree of vigilance for nutritional deficiencies and bone loss in patients both before and after bariatric surgery is critical," the researchers write.

Dr. Shonni J. Silverberg and colleagues from Columbia University College of Physicians and Surgeons in New York City explain that after people have obesity surgery, they have a smaller gut area available to absorb nutrients from the food they eat. Evidence is mounting that weight-loss surgery may impair bone and mineral metabolism, the team notes in the Journal of Clinical Endocrinology and Metabolism.

To investigate, they followed 23 men and women who had undergone Roux-en-Y gastric bypass surgery, one of the most popular types of weight-loss surgery. This operation involves bypassing the duodenum, the portion of the small intestine that joins to the stomach, which is the chief site of calcium absorption by the body.

Before the surgery, the patients had less-than-optimal blood levels of vitamin D, even though their intake of the nutrient was relatively high.
After the surgery, they doubled their calcium intake and were consuming 2.6 times more vitamin D, but their blood levels of vitamin D remained low, and their blood levels of calcium actually fell.

Signs of poor calcium absorption appeared within three months of the surgery. Concentrations of parathyroid hormone, which fosters release of calcium from the bones, had been in the high normal range before the operation, and increased after the surgery.

Within a year of the surgery, patients had lost an average of 45 kilograms in weight. At that point, the density of their upper thigh bones had dropped by 9.2% and their hip bone density fell 8%, but most patients didn't show loss of bone density in the lower back or the forearm.

The degree of bone loss was closely linked to how much weight patients lost, Silverberg and colleagues found. This may have occurred, the researchers suggest, because bones no longer had to bear as much weight, and weight-bearing is a key component of maintaining and building bone strength. Increased secretion of parathyroid hormone could also have been a factor, they add.

"The small sample size of this study argues for larger, long-term studies to answer the critical question of how these losses relate to bone quality and fracture risk," the researchers state.

SOURCE: Journal of Clinical Endocrinology and Metabolism, published online July 22, 2008.

Here is the website link if you're curious.
And, again, the study argues for "larger, long-term studies." Big surprise...not enough research about WLS and its after effects!

Bones may weaken after weight loss surgery | Health | Reuters

Anonymous · 03-18-2009, 01:32 AM

My Godmother had GBS and she's going through this same thing. She is on medication for bone loss and low calcium. It's kinda painful too.

Phoenixfire · 03-18-2009, 01:52 AM

Quote:

Originally Posted by Anonymous

My Godmother had GBS and she's going through this same thing. She is on medication for bone loss and low calcium. It's kinda painful too.

Interesting...I've had a baffling increase in my level of chronic pain. I hadn't discovered yet that it could be related to this!

THANK YOU ANONYMOUS, I really am glad you posted this!

JimM · 03-18-2009, 06:50 AM

I wonder if strength training (e.g. weight lifting) would help counter this risk? I've see from other literature that weight lifting can improve bone density... Hmmm...

MiladyB · 03-18-2009, 07:18 AM

Jim, I would think that weight training could improve the density of the bones. I know for people that have osteoporosis exercise of the long bones is highly encouraged.

After weight loss surgery; primarily after RNY or DS our bodies do not effectively absorb the calcium from our diets. That is why we are told to be taking such large doses of calcium a day and why it is encouraged to be taking the most absorbable form, which is citrate. What many people don't realize is that a normal blood calcium level doesn't really indicate if you are getting enough calcium. Our bodies work hard at maintaining a normal blood calcium level so if there isn't enough calcium, our body it will take from our bones and our teeth...just so that the calcium level will remain normal.

The most effective ways of measuring the situation is keeping track of your PTH plus a bone density test. The recommendation is that all weight loss surgery patients get a bone density test 1 year post-op. If the results are good that test should be done every other year. If there are signs of problems then it should be followed yearly. This is for ALL patients regardless of age or sex.

Corrine · 03-18-2009, 08:25 AM

I'm truly sorry you're having problems with bone density Phoenix but I couldn't be happier that you've posted this.

Sadly, there are too few doctors who even mention this aspect of WLS. I know that mine didn't and I had to ask for a DEXA scan.

Godsblessedme · 03-18-2009, 09:12 AM

great informative post Kris! i'm sorry your density is low and surely that could be why your chronic pain is coming back, i'm glad that your on top of this and letting others know this is a real possibility.

JimM · 03-18-2009, 01:18 PM

Quote:

Originally Posted by MiladyB

The most effective ways of measuring the situation is keeping track of your PTH plus a bone density test. The recommendation is that all weight loss surgery patients get a bone density test 1 year post-op. If the results are good that test should be done every other year. If there are signs of problems then it should be followed yearly. This is for ALL patients regardless of age or sex.

Wow, I'm over 3 1/2 years post-op and I've never had a bone density test. I printed out the link Phoenix posted above and will be taking it with me to my Dr. appt. on Friday - I'm going to ask for a Dexa scan (and may see about a body composition analysis, too... like Eric recently had).

Anonymous · 03-18-2009, 11:57 PM

Quote:

Originally Posted by Phoenixfire

Interesting...I've had a baffling increase in my level of chronic pain. I hadn't discovered yet that it could be related to this!

THANK YOU ANONYMOUS, I really am glad you posted this!

I will talk with her more about it the next time I see her. Do you think you caught it early enough? Or is there no "early enough"?

Phoenixfire · 03-19-2009, 12:39 PM

Quote:

Originally Posted by Anonymous

I will talk with her more about it the next time I see her. Do you think you caught it early enough? Or is there no "early enough"?

No, I don't think I caught it early enough. I'm not happy at all.

I'm fearful of my future. Sadly I wasn't aware of this complication before now. I'm glad my PCP recommended the test because most docs do this test for the over 50 crowd. God only knows how much loss I'd have at 50 if I didn't start treatment for it NOW.

The recommendation from doctors NOW is to get tested prior to surgery and then a year after. Getting a DEXA scan is something a lot of people don't think about when they are young. Being over 6 years out, I think my bones have lost density for quite awhile now. Much much much more than is normal for my age.

It's very worrisome, but at least I'm working on keeping the density I've got now. To answer an earlier post, if I were YOUNG I'd still get a DEXA scan. It looks like it should be in the same league as the blood test protocols for post WLS.