Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery
Purpose: Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-06-01
|
| Series: | Bone Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187221000152 |
| _version_ | 1818650912404537344 |
|---|---|
| author | Yi Liu Maya M. Côté Michael C. Cheney Katherine G. Lindeman Claire C. Rushin Matthew M. Hutter Elaine W. Yu |
| author_facet | Yi Liu Maya M. Côté Michael C. Cheney Katherine G. Lindeman Claire C. Rushin Matthew M. Hutter Elaine W. Yu |
| author_sort | Yi Liu |
| collection | DOAJ |
| description | Purpose: Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to examine the preliminary safety and efficacy of zoledronic acid (ZOL), a potent anti-resorptive bisphosphonate, to suppress bone turnover markers (BTM) and prevent declines in bone mineral density (BMD) after Roux-en-Y gastric bypass (RYGB) surgery. Methods: We performed an open-label pilot study of pre-operative ZOL in postmenopausal women with obesity who were planning RYGB (n = 4). A single dose of zoledronic acid 5 mg was given intravenously prior to RYGB. Serum bone biochemistries including C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at multiple timepoints throughout the 24-week study. BMD was also obtained at the spine and hip by dual-energy x-ray absorptiometry (DXA) and at the trabecular spine by quantitative computed tomography (QCT) at pre-operative baseline and 24 weeks. Results were compared against pre-operative baseline and against changes among RYGB historical controls (n = 10). Results: At 2 weeks after RYGB, there was a nonsignificant trend for CTX and P1NP levels to be lower than baseline levels in the ZOL group. By 24 weeks after RYGB, however, participants who received ZOL had a significant increase in CTX above pre-operative baseline (+0.228 ± 0.117 ng/dL, p = 0.030) but this CTX rise was less than that observed in the controls (+0.601 ± 0.307 ng/dL, p = 0.042 between groups). Despite ZOL use, participants had significant areal BMD loss at the total hip as compared to pre-operative baseline (−4.2 ± 1.5%, p = 0.012) that was similar in magnitude to total hip BMD loss in the controls (−5.5 ± 3.9%, p = 0.005). There was a suggestion that the ZOL group might be protected against trabecular spine volumetric bone loss as compared to the control group (+4.8 ± 8.0% vs. -5.9 ± 7.0%, p = 0.075 between groups). Serum calcium, 25-hydroxyvitamin D, and parathyroid hormone did not change in either group. No hypocalcemia or serious adverse events were reported after ZOL. Conclusion: In this proof of concept study, a single dose of ZOL prior to RYGB appeared to transiently mitigate but not fully prevent high bone turnover in the acute postoperative period. At 24 weeks after RYGB, our preliminary data suggest that ZOL was not sufficient to prevent bone loss at the hip, although it may preserve bone density at the trabecular spine. Further prospective, controlled studies are needed to confirm our findings and to identify the best strategies for preventing bone loss in bariatric patients receiving RYGB. |
| first_indexed | 2024-12-17T01:57:45Z |
| format | Article |
| id | doaj.art-92abb0b61ddf457a90b0cca021da97fa |
| institution | Directory Open Access Journal |
| issn | 2352-1872 |
| language | English |
| last_indexed | 2024-12-17T01:57:45Z |
| publishDate | 2021-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Bone Reports |
| spelling | doaj.art-92abb0b61ddf457a90b0cca021da97fa2022-12-21T22:07:55ZengElsevierBone Reports2352-18722021-06-0114100760Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgeryYi Liu0Maya M. Côté1Michael C. Cheney2Katherine G. Lindeman3Claire C. Rushin4Matthew M. Hutter5Elaine W. Yu6Department of Medicine, Lahey Clinic, Burlington, MA, USAEndocrine Unit, Massachusetts General Hospital, Boston, MA, USAEndocrine Unit, Massachusetts General Hospital, Boston, MA, USAEndocrine Unit, Massachusetts General Hospital, Boston, MA, USAEndocrine Unit, Massachusetts General Hospital, Boston, MA, USAHarvard Medical School, Boston, MA, USA; Department of Surgery, Weight Center, Massachusetts General Hospital, USAEndocrine Unit, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Corresponding author at: Endocrine Unit, Massachusetts General Hospital, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA.Purpose: Bariatric surgery is an effective treatment for severe obesity but causes substantial bone loss and increased risk of fractures. To date, there have been no studies examining whether pharmacologic treatments can prevent bone loss after bariatric surgery. We performed an exploratory study to examine the preliminary safety and efficacy of zoledronic acid (ZOL), a potent anti-resorptive bisphosphonate, to suppress bone turnover markers (BTM) and prevent declines in bone mineral density (BMD) after Roux-en-Y gastric bypass (RYGB) surgery. Methods: We performed an open-label pilot study of pre-operative ZOL in postmenopausal women with obesity who were planning RYGB (n = 4). A single dose of zoledronic acid 5 mg was given intravenously prior to RYGB. Serum bone biochemistries including C-telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP) were measured at multiple timepoints throughout the 24-week study. BMD was also obtained at the spine and hip by dual-energy x-ray absorptiometry (DXA) and at the trabecular spine by quantitative computed tomography (QCT) at pre-operative baseline and 24 weeks. Results were compared against pre-operative baseline and against changes among RYGB historical controls (n = 10). Results: At 2 weeks after RYGB, there was a nonsignificant trend for CTX and P1NP levels to be lower than baseline levels in the ZOL group. By 24 weeks after RYGB, however, participants who received ZOL had a significant increase in CTX above pre-operative baseline (+0.228 ± 0.117 ng/dL, p = 0.030) but this CTX rise was less than that observed in the controls (+0.601 ± 0.307 ng/dL, p = 0.042 between groups). Despite ZOL use, participants had significant areal BMD loss at the total hip as compared to pre-operative baseline (−4.2 ± 1.5%, p = 0.012) that was similar in magnitude to total hip BMD loss in the controls (−5.5 ± 3.9%, p = 0.005). There was a suggestion that the ZOL group might be protected against trabecular spine volumetric bone loss as compared to the control group (+4.8 ± 8.0% vs. -5.9 ± 7.0%, p = 0.075 between groups). Serum calcium, 25-hydroxyvitamin D, and parathyroid hormone did not change in either group. No hypocalcemia or serious adverse events were reported after ZOL. Conclusion: In this proof of concept study, a single dose of ZOL prior to RYGB appeared to transiently mitigate but not fully prevent high bone turnover in the acute postoperative period. At 24 weeks after RYGB, our preliminary data suggest that ZOL was not sufficient to prevent bone loss at the hip, although it may preserve bone density at the trabecular spine. Further prospective, controlled studies are needed to confirm our findings and to identify the best strategies for preventing bone loss in bariatric patients receiving RYGB.http://www.sciencedirect.com/science/article/pii/S2352187221000152Bariatric surgeryGastric bypassBone lossZoledronic acidBisphosphonatesBone turnover marker |
| spellingShingle | Yi Liu Maya M. Côté Michael C. Cheney Katherine G. Lindeman Claire C. Rushin Matthew M. Hutter Elaine W. Yu Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery Bone Reports Bariatric surgery Gastric bypass Bone loss Zoledronic acid Bisphosphonates Bone turnover marker |
| title | Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| title_full | Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| title_fullStr | Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| title_full_unstemmed | Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| title_short | Examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| title_sort | examining zoledronic acid for the prevention of bone loss in patients receiving bariatric surgery |
| topic | Bariatric surgery Gastric bypass Bone loss Zoledronic acid Bisphosphonates Bone turnover marker |
| url | http://www.sciencedirect.com/science/article/pii/S2352187221000152 |
| work_keys_str_mv | AT yiliu examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT mayamcote examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT michaelccheney examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT katherineglindeman examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT clairecrushin examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT matthewmhutter examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery AT elainewyu examiningzoledronicacidforthepreventionofbonelossinpatientsreceivingbariatricsurgery |