Efectos de la cirugía bariátrica sobre el metabolismo óseo / Effects of bariatric surgery on bone health

ABSTRACT

There is concern about the long term complications of bariatric surgery and among these, the derangements in bone metabolism that could increase the risk of osteopororosis. Most studies show an elevated bone turnover in operated patients with loss of bone mass, that are partially explained by the development of a secondary hyperparathyroidism. We have shown that, among postmenopausal women, bone resorption remains elevated, even five years after the operation, although not associated to loss of bone mass. The pathophysiology of these alterations is complex and includes an reduction in mechanical load and calcium absorption and postoperative changes in signaling hormones that have an effect on bone, coming from adipose tissue (estrogens, leptin and adiponectin), liver (insulin like growth factor-1), pancreas (insulin and amylin) or the bowel (ghrelin, glucagon-like peptide 2, peptide YY, gastric inhibitory polypeptide). Available evidence suggest that bariatric surgery should be considered a risk factor for osteoporosis. We recommend the incorporation of bone health in pre operative evaluation. We also give suggestions to prevent the adverse effects of bariatric surgery on bone health.