In the Journals Plus

BMD may decrease after RYGB

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July 10, 2017

Adults who undergo Roux-en-Y gastric bypass may have low bone mineral density that is correlated with the amount of weight lost and may be at risk for vitamin D and calcium deficiencies compared with adults who did not undergo Roux-en-Y gastric bypass, published findings show.

Fiona Jackson Cook, MD, FACE, of the division of endocrinology, Brody School of Medicine in Greenville, North Carolina, and colleagues evaluated 51 adults (mean age, 58.6 years; 45 women) who underwent Roux-en-Y gastric bypass (RYBG; mean time since surgery, 17 years) to determine BMD and fracture prevalence after surgery.

Fiona Cook
Fiona Jackson Cook

Before surgery, mean BMI was 53.9 kg/m2. After surgery, mean maximum weight loss was 70.3 kg and mean net weight loss was 46.9 kg.

Participants had relatively low median daily dietary calcium (582.5 mg) and protein (50.2 g) intakes. Vitamin D median daily intake was 1,000 IU.

A history of fracture since RYGB was present in 15.7% of participants and 27.5% had osteoporosis.

Overall, 39% of participants had vitamin D deficiency, 35% had vitamin D insufficiency and 37% had secondary hyperparathyroidism. Distal radius z score and net change in BMI were negatively correlated (P < .001), and net change in BMI was higher in participants with osteoporosis compared with those without (P < .05).

“As the population of post gastric bypass patients increases in number and age, we anticipate that osteoporotic fracture and osteomalacia will be of increasing clinical concern in these patients,” Cook told Endocrine Today. “BMD evaluation and nutritional supplementation are likely of great importance in this high-risk population. There is a strong need for better education of both patients and physicians regarding the importance of long-term follow-up care after bariatric surgery. Prospective long-term studies are needed to gather the information necessary to improve guidelines for preventive care, particularly for those with other osteoporosis risk, including all postmenopausal women.” – by Amber Cox

For more information:

Fiona Jackson Cook, MD, FACE, can be reached at Division of Endocrinology, Brody 3E-129, 600 Moye Blvd., Greenville, N.C., 27834; email:

Disclosure: Cook reports no relevant financial disclosures. The study was funded by a grant from the East Carolina Diabetes and Obesity Institute.