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When weight loss surgery steals your bone density
Obesity can be a death sentence.
According to the National Institutes of Health, obesity-related conditions are responsible for about 300,00 deaths per year in the United States.
Diet and exercise can reverse obesity for many people. But thousands of people each year turn to gastric bypass surgery as a more drastic method for losing weight quickly.
Unfortunately, the sudden weight loss that comes after such surgery (as much as 60 pounds in the first month) comes with risks of its own…
Numerous studies have shown that a loss of bone mineral density (BMD) follows this rapid weight loss. This is especially true if you’re not exercising.
Loss of bone mineral density spells bones that fracture more easily. And that means a simple fall could be disastrous.
Unfortunately, research is consistent in showing that gastric bypass surgery leads to more fragile bones.
If you’re worried about your weight and considering gastric bypass, the last thing you want is the added burden of a broken hip, knee or shoulder. So it’s important to make an informed decision…
What is a gastric bypass?
There are four types of gastric bypass surgery available:
- Roux-en-Y gastric bypass
- Laparoscopic adjustable gastric banding (Lap-band)
- Sleeve gastrectomy
- Duodenal switch with biliopancreatic diversion
They all accomplish one of two things or both: They reduce stomach size, and they change the way food gets digested. In other words, they restrict the amount of calories you can physically take into your stomach — and/or cause malabsorption by reducing not just the amount of calories your body can absorb, but also the nutrients.
The Lap-band and Sleeve gastrectomy only reduce calorie intake, and not calorie or nutrient absorption since these procedures don’t include altering the way food travels to the intestines.
The procedures can cost anywhere from $15,000 to $35,000, depending on the one you opt for. And the question of whether insurance covers them or not is something you’d need to explore with your individual health insurance company.
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Weight loss surgery leads to fracture risk
Research has been consistent in showing that gastric bypass steals your bone minerals and causes fragile bones and joints.
A 2014 retrospective cohort study (review of previous data) looked at the incidence of fracture following bariatric surgery among 258 residents of a county in Minnesota. The researchers reached the conclusion that “bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.”
A year later, in 2015, Chinese researchers found a similar association among bariatric surgery, lowered bone mass density and fractures.
They speculated that, since estrogen is important in preventing bone resorption (the gradual transfer of calcium out of the bones), and since fatty tissue is a main site for estrogen production, the sudden loss of fat following bariatric surgery could reduce estrogen enough to weaken bones and increase risk of fracture.
And, very recently, Swedish researchers also found that the long-term risk of fracture was 2.58 times greater among patients who underwent weight-loss surgery than among those who didn’t.
Fracture risk was also twice as high among people who opted for gastric bypass, as opposed to gastric banding.
There is no magic bullet
As you can see the research goes back quite a few years, so that means this problem is not new to the scientific community or health professionals.
It also means surgery isn’t an easy fix option. It demands proper followup care and nutritional guidance to help defeat the problems surrounding bone loss.
In fact, the American Association of Clinical Endocrinologists (AACE), The Obesity Society, and American Society for Metabolic and Bariatric Surgery (ASMBS) state that DXA bone density scans are indicated both preoperatively and 2 years after bariatric surgery.
In addition to screening bariatric surgery patients for bone changes, clinicians must also closely monitor calcium and vitamin D levels before and after surgery. And lifelong supplementation of these nutrients (calcium citrate is preferred over calcium carbonate) is recommended.
So, if you’re considering surgery for weight loss be sure to discuss this with your doctor so you can be sure he understands this risk and has a plan to counter it.
But if this information causes you concern, remember there are other ways to lose weight. Though surgery may seem like a magic bullet at first, it obviously has its drawbacks.
In the last of a series of articles on weight loss, Dr. Michael Cutler offers 22 sensible, healthy weight loss tips that take into account not only diet and exercise but mindset and motivation.
If you’re ready to start your weight loss journey, his series is a good read.
Sources:
- Fracture risk after three bariatric surgery procedures in Swedish obese subjects: up to 26 years follow‐up of a controlled intervention study — Journal of Internal Medicine
- Fracture risk following bariatric surgery: a population-based study — Osteoporosis International
- Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study — Medicine
- Fracture Risk After Gastric Bypass Surgery: A Retrospective Cohort Study — Journal of Bone and Mineral Research
- Fracture Risk After Roux-en-Y Gastric Bypass vs Adjustable Gastric Banding Among Medicare Beneficiaries — JAMA Surgery
- Clinical Challenges: Osteoporosis Risk After Bariatric Surgery — Medpage Today
By Joyce Hollman
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