Obesity surgery thins bones, but.....

[cougarnurse]

Enough to break? Obesity surgery thins bones, but enough to break? - Yahoo! News

It isn't just the thunder thighs that shrink after obesity surgery. Melting fat somehow thins bones, too. Doctors don't yet know how likely patients' bones are to thin enough to break in the years after surgery. But one of the first attempts to tell suggests they might have twice the average person's risk, and be even more likely to break a hand or foot.

The Mayo Clinic's finding is surprising, and further research is under way to see if the link is real. But with bariatric surgery booming and even teenagers in their key bone-building years increasingly trying it, specialists say uncovering long-term side effects and how to counter them takes on new urgency.

Simply popping today's doses of calcium supplements may not be enough.

"These procedures are now being sold as a panacea," Dr. Shonni Joy Silverberg of Columbia University told last week's annual meeting of The Endocrine Society, where the fat-and-bone relationship took center stage. "It is of heightened importance to find the answers to these questions."

Here's the irony: Obesity actually is considered protective against bone-weakening osteoporosis, possibly the only positive thing you'll ever hear a doctor say about too much fat.

"They're starting better than most of us," cautions Mayo bone-metabolism expert Dr. Jackie Clowes. So the big question is whether they really end up with worse bones, or just go through a transition period as their bones adjust to their new body size.

About 15 million Americans are classified as extremely obese, 100 pounds or more overweight. Dieting alone doesn't make enough of a dent to fend off rampant diabetes and other health problems, so surgery is fast becoming the preferred treatment — from the stomach stapling called gastric bypass to less invasive stomach banding. Patients tend to lose between 15 percent and 25 percent of their original weight, and diabetes dramatically improves.

More than 1.2 million U.S. patients have undergone the surgery in the past decade, 220,000 in the last year alone, according to the American Society for Metabolic and Bariatric Surgery.

There's little data on how patients fare many years later; large National Institutes of Health studies, on both adults and teens, are under way.
But doctors have long noted that the radical weight loss can speed bone turnover until the breakdown of old bone outpaces the formation of new bone. Silverberg cites recent studies showing that a year after gastric bypass, adults' hip density drops as much as 10 percent, raising concern about a common fracture site of old age. (Stomach banding causes less thinning because it doesn't alter nutrient absorption as much.)

No one knows if teen bones react similarly, but it's an important issue because almost half of peak bone mass develops during adolescence.
To see if such changes translate into fractures, the Mayo team is comparing the medical records of nearly 300 adults who've had bariatric surgery with similarly aged Minnesotans who haven't.

A quarter of the 142 surgery recipients studied so far experienced at least one fracture in the following years, Mayo's Dr. Elizabeth Haglind told the endocrinology meeting. Six years post-surgery, that group had twice the average risk. But in a puzzling finding, the surgery recipients had even more hand and foot fractures than their Minnesota neighbors, three times the risk.

Those fractures aren't usually connected to osteoporosis. Did the once-obese merely start exercising and just fall down more? Clowes doubts it.

"I was shocked" at the numbers, says Dr. Scott Shikora, president of the bariatric surgeons group, who says he hasn't seen a significant fracture problem in his own practice.

Surgeons routinely tell patients to take some extra calcium and vitamin D. Shikora estimates about half follow that advice, and other research suggests higher doses may be needed anyway as the obese tend to start out deficient in vitamin D.

A key next step will be to compare the patients who fracture with people of the same weight to see if their bone mass just had to adjust — or if something about surgery alters the complex soup of hormones and other factors that keep bones strong, thus requiring more than extra calcium.

Clowes' advice for now: Don't skip checkups, where doctors monitor bone health, and aggressively treat nutrient deficiencies.

[Ricu]

This article talks about the change in the bariatric patients weightload bearing as being the primary issue behind bone decalcification and while I agree that loadbearing is responsible for building bone strength, I don't subscribe to the theory that this is the only reason that these individuals are suffering critical bone loss.


More to the point, I think there's going to be a connection to nutritional, especially in this case, mineral absorption. I realize that the required mineral/vitamin complement is taken by the post-surgical bariatric patient in supplement form along with the tablespoon of food q4hrs or so and sure, they may be losing weight but from a quality nutritional standpoint are they getting what they need?

In terms of supplement preparation, there is a bioavailability factor that must be considered. While one may take supplements, those component substances may not be manufactured into a form which the body can asssimilate or be taken in conjunction with other elements which enhance or facilitate absorption. When you don't take in the required amount of in this case, calcium, your body will catabolize its own source of the mineral, bone tissue, in order to use it in other more critical areas like impulse conduction.

I realize that many patients having undergone this surgery are successful but how many? How many are not? Given this report, there's evidence to question whether any comprehensive lifestyle and nutritional study has been done say, six months out. Are the supplements evaluated for bioavailability? Additionally, weight training promotes bone strength. As part of their postoperative education, are the patients advised of this and are they being instructed?

Finally, knowing how much the issues of obesity and nutrition are lifestyle related, what part of of this problem can be attributed to patient compliance?



R

[cougarnurse]

I know a co-worker of mine had it done, and she has had good results. Tried everything else, and understands the whole thing. She complies, and has kept off the wt for the past several years.

Re: lifestyles: how can you account for the one person in a family that has a wt. problem, yet watches intake? I have often wondered that over the years.

[Ricu]

Originally Posted by cougarnurse

I know a co-worker of mine had it done, and she has had good results. Tried everything else, and understands the whole thing. She complies, and has kept off the wt for the past several years.

Re: lifestyles: how can you account for the one person in a family that has a wt. problem, yet watches intake? I have often wondered that over the years.

I, too, know several people who have had gastric bypass surgery and they have had mixed results. One has done very well and the other two have not done quite as well. Of those two, one has gained back all lost weight plus some and is miserable and the other has had moderate weight loss success and has experienced chronic symptoms similar to dumping syndrome even though she carefully monitors intake volume.

On the matter of the one individual in the family who suffers weight management issues while the others do not, the problem is likely multifocal. Factors like age, gender, hereditary metabolic disorder, and activity all could be responsible. Is the individual really sure about intake, too? It might be a useful thing to keep a dietary journal for a couple of days. Once it's been tracked, many people who are convinced that their intake is ideal, have been really surprised by the amount and/or type of foods and drinks taken during the day.

R

[Rick(SoCal)]

I can speak from personal experience, this is not an easy fix. I had the Gastric Bypass specifically the RnY surgery on 02/06/2009. This surgery was a last resort for my and was out of options. I have lost so far 139 pounds and have had no real side effects. Had only one burp where my intestines got blocked but after a few days in the hospital, that too passed LOL.

I am worried about the bone issue as well. More and more fractures are appearing as more people go through with this surgery. But all we can do as patients is follow the doctors protocol. My doctor is real strict as far as the protein intake and the calcium supplements.

I have seen alot of great success with the surgery but have seen some failures as well. My sister in law had the same surgery I had several years ago and traded the food addiction with alcohol. She has gained 90% of here weight back after losing over 180 pounds.

All we can do as nurses is help educate our patients about all that is involved which includes the risks. I dont believe in sugar coating this issue with patients and believe they need to know all. One of our classmates that had the RnY done passed away approx 2 1/2 weeks after the surgery do to complications of pneumonia.

Rick

[cougarnurse]

See this post: Obesity surgery deaths low, says study

I thought it interesting.