Key result
Gastric bypass resulted in significantly lower levels of serum 25-hydroxyvitamin D (MD -1.85) and calcium, and higher levels of parathyroid hormone and phosphorus compared to sleeve gastrectomy.
Why the study?
Gastric bypass and sleeve gastrectomy carry potential complications including bone metabolism-related diseases, but no meta-analysis comparing them had been performed.
Does gastric bypass compared to sleeve gastrectomy worsen bone metabolism markers in obese patients?
Meta-Analysis (n=1,503)
Does gastric bypass compared to sleeve gastrectomy worsen bone metabolism markers in obese patients?
Mean Difference: -1.85 (95% CI -3.32–-0.39)
p-value: p=0.01
Gastric bypass is associated with worse bone metabolism markers (lower calcium and vitamin D, higher PTH and phosphorus) compared to sleeve gastrectomy, suggesting a need for closer monitoring and higher supplementation in GB patients.
BMD monitoring warranted after sleeve gastrectomy; confirms bone loss at hip and femoral neck despite favorable lab shifts.
BACKGROUND: Gastric bypass (GB) and sleeve gastrectomy (SG) are two common types of bariatric surgery that carry many potential complications. Among these complications, bone metabolism-related diseases have attracted substantial attention; however, no meta-analysis of them has been performed to date. METHODS: We searched PubMed, Web of Science, The Cochrane Library, and Embase to identify relevant studies published before January 2019. The following indicators were evaluated: serum parathyroid hormone (PTH), calcium, phosphorus and 25-hydroxyvitamin D levels, body mass index (BMI), and bone mineral density (BMD). RESULTS: Thirteen studies met our inclusion criteria. Overall results showed that patients undergoing GB had lower levels of 25-hydroxyvitamin D (MD = - 1.85, 95% CI (- 3.32, - 0.39) P = 0.01) and calcium (MD = - 0.15, 95% CI (- 0.24, - 0.07) P = 0.0006) as well as higher levels of PTH (MD = 3.58, 95% CI (0.61, 7.09) P = 0.02) and phosphorus (MD = 0.22, 95% CI (0.10, 0.35) P = 0.0005). The results of BMI and BMD were comparable in each group. CONCLUSION: Our meta-analysis suggested that obese patients undergoing GB had lower levels of serum calcium and 25-hydroxyvitamin D as well as higher levels of serum phosphorus and PTH. To prevent postoperative bone metabolism-related diseases, appropriate postoperative interventions should be undertaken for particular surgical procedures.
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Tian et al. (2019) conducted a meta-analysis in Obesity (n=1,503). Gastric bypass vs. Sleeve gastrectomy was evaluated on Serum 25-hydroxyvitamin D levels (MD -1.85, 95% CI -3.32, -0.39, p=0.01). Gastric bypass resulted in significantly lower levels of serum 25-hydroxyvitamin D (MD -1.85) and calcium, and higher levels of parathyroid hormone and phosphorus compared to sleeve gastrectomy.
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