Get access

Bariatric surgery, bone loss, obesity and possible mechanisms

Authors

  • M. M. Brzozowska,

    1. Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
    Search for more papers by this author
  • A. Sainsbury,

    1. The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, The University of Sydney, Australia
    2. School of Medical Sciences, University of New South Wales, Sydney, Australia
    Search for more papers by this author
  • J. A. Eisman,

    1. Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
    2. Clinical School, St Vincent's Hospital, Sydney, Australia
    3. Faculty of Medicine, University of New South Wales, Sydney, Australia
    4. Clinical Translation and Advanced Education Department, Garvan Institute of Medical Research, Sydney, Australia
    5. Faculty of Medicine, University of Notre Dame, Sydney, Australia
    Search for more papers by this author
  • P. A. Baldock,

    1. Clinical School, St Vincent's Hospital, Sydney, Australia
    2. Faculty of Medicine, University of New South Wales, Sydney, Australia
    3. Neurological Disease Division, Garvan Institute of Medical Research, Sydney, Australia
    Search for more papers by this author
  • J. R. Center

    Corresponding author
    1. Clinical School, St Vincent's Hospital, Sydney, Australia
    2. Faculty of Medicine, University of New South Wales, Sydney, Australia
    • Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
    Search for more papers by this author

Address for correspondence: A/Prof JR Center, Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, 384 Victoria Street, Darlinghurst, Sydney, NSW 2010, Australia.

E-mail: j.center@garvan.org.au

Summary

Bariatric surgery remains the most effective treatment for severely obese patients. However, the potential long-term effects of bariatric surgical procedures on health, including bone health, are only partially understood. The goal of this review was to present data on the impact of bariatric surgery on bone metabolism and to analyse possible reasons for the loss of bone mass that frequently occurs after bariatric surgery. Such factors include nutritional deficiencies, rapid weight loss per se, effects of fat-derived adipokines and gut-derived appetite-regulatory hormones. However, the relative roles of these factors in skeletal regulation and the mechanisms by which they work are not yet fully defined. Our review was focussed on the complex relationship between body weight, fat mass and bone mass, as well as peripheral and central mediators potentially involved in the dual regulation of both energy and bone homeostasis. We also review the data on the inverse relationship between central obesity, bone marrow fat and osteoporosis. As the number of bariatric operations increases, it is imperative to recognize mechanisms responsible for bariatric surgery-induced bone loss, with careful monitoring of bone health including long-term fracture incidence in patients undergoing these procedures.

Get access to the full text of this article

Ancillary