Weight-loss surgery could cause weak bones, warn doctors
Gastric surgery - used to treat obese
patients who struggle to lose weight by other means - could also cause
bone loss, say researchers. The various procedures curtail the amount of
food a person can eat, either via a reversible gastric band or
permanent operation like a bypass
Now endocrinologists say they
can also lower bone density, which is of particular concern for teenage
patients who have not yet reached their peak bone mass.
Patients
unable to lose weight with a BMI over 40 are eligible for bariatric
surgery on the NHS Dr Malgorzata Brzozowska from Sydney’s Garvan
Institute of Medical Research, performed a widespread review of current
research into the complex interrelationships between fat, bone and
nutritional restriction.
She said: 'The more invasive types of
surgery appear to heighten bone turnover and the associated bone loss.
'This is thought to be caused not only by rapid weight loss and
absorption of fewer vital nutrients like vitamin D and calcium, but
possibly also by changes in hormones released by fat and the gut, and
their impact on the central nervous system.'
In the United
States, ‘Roux-en-Y’ gastric bypass surgery, one of the most invasive of
the procedures, is the most common. Much of the stomach is removed and
part of the small bowel bypassed.
Last year there were 5,407 gastric bypass operations in the UK compared to 858 procedures in 2006. Gastric
Bypass Less radical is the ‘gastric sleeve’, which involves removing a
large part of the stomach leaving a narrowed smaller stomach,restricting
food intake and at the same time speeding the passage of food to the
gut. The least invasive, and only reversible measure, is the‘gastric
band’, which is an inflatable ring placed between the oesophagus and
stomach, making it possible to eat only small amounts of food slowly.
Dr
Brzozowska and Associate Professor Jackie Center, say that skeletal
examination and treatment should be considered part of patient care,
before and after gastric procedures. Associate Professor Jackie Center,
said: 'We are certainly not arguing against bariatric surgery. There is
no doubt that it is an effective weapon against obesity and
obesity-related diabetes. We just ask that doctors and patients take
bone health into account. 'Bone mineral densitometry scans can be done
and adequate calcium and vitamin D intake advised. For those patients at
particular risk, additional monitoring may be advised and protective
drugs considered.'
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