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Bariatric surgery – Effects on bone density
e12 should be defined and, if unsuccessful, consideration should then be given to a surgical option. The safety, effectiveness, reversibility and adjustability of gastric banding makes it preferred over gastric stapling procedures, such as sleeve gastrectomy or gastric bypass.
Abstracts on long term bone outcomes following bariatric surgery. http://dx.doi.org/10.1016/j.orcp.2013.12.522 24
http://dx.doi.org/10.1016/j.orcp.2013.12.521
Bariatric surgery — Effects on glucose homeostasis
23
John Dixon
Bariatric surgery — Effects on bone density
Baker IDI Heart & Diabetes Institute, Melbourne, Vic, Australia
Jackie Center
Bariatric-metabolic surgery provides substantial, sustained weight loss and major improvements in glycaemic control in severely obese individuals with type 2 diabetes. I will examine the indications for, and efficacy and safety of, conventional bariatric surgical procedures and their effect on glycaemic control in type 2 diabetes. How often very simple surgical gastrointestinal interventions achieve sustained changes in energy and glucose homeostasis is of great research interest, and understanding is evolving rapidly. The effect of weight loss appears critical to both short and longer term outcomes and evidence supporting this will be provided. However, there are some clear effects beyond weight loss with some specific anatomical arrangements that are elements of some surgical procedures. The early remission of type 2 diabetes with Roux-en-Y gastric bypass has been of particular interest and a growing array of gastrointestinal changes generated by this procedure is now evident, and many of these changes may influence glucose homeostasis. While very exciting some caution is recommended as the durability of beyond ‘weight loss’ effects is unclear, and there are issues in translating rodent experimental data to humans. The role of the gut in glucose homeostasis is becoming clearer and could provide insights into the pathogenesis of type 2 diabetes and assist in the development of new procedures, devices and drugs both for obese and non-obese patients.
Garvan Institute of Medical Research and St Vincent’s Hospital, Darlinghurst, NSW, Australia Body weight is one of the best predictors of bone density. Low body weight has been associated with low bone mass and increased fracture risk, and high body weight with high bone mass. Furthermore, weight loss has been associated with bone loss and osteoporotic fractures. The strong positive relationship between body weight and bone mass had largely been thought to be due to mechanical loading. However, this relationship is more complex than simple load bearing or the response of bone to muscle-induced strain. Adipocytes and osteoblasts originate from a common mesenchymal precursor and regulation of fat and bone cells appears to be more closely co-ordinated, through both central and peripheral pathways, than previously realised. Moreover, recent data suggest that obesity may not confer the protective effect against fracture as was once thought, with higher than expected prevalence of fractures in obese children and adults. Bariatric surgery is associated with significant weight loss and some types of surgery, specifically Roux-en-Y gastric bypass surgery has been associated with significant bone loss although this does not appear to be the case with gastric banding. Data on gastric sleeve surgery, growing in popularity in Australia, is limited. However, the degree of weight loss and many of the gut hormonal responses following gastric sleeve surgery are similar to gastric bypass, presenting the possibility that bone health may be adversely affected following this type of surgery. This talk will discuss some of the complexities surrounding the bone—fat relationship, the available data on bone density and fracture following different types of bariatric surgery as well as present some recent data from a current study
http://dx.doi.org/10.1016/j.orcp.2013.12.523
Abstracts on long term bone outcomes following bariatric surgery. http://dx.doi.org/10.1016/j.orcp.2013.12.522 24
http://dx.doi.org/10.1016/j.orcp.2013.12.521
Bariatric surgery — Effects on glucose homeostasis
23
John Dixon
Bariatric surgery — Effects on bone density
Baker IDI Heart & Diabetes Institute, Melbourne, Vic, Australia
Jackie Center
Bariatric-metabolic surgery provides substantial, sustained weight loss and major improvements in glycaemic control in severely obese individuals with type 2 diabetes. I will examine the indications for, and efficacy and safety of, conventional bariatric surgical procedures and their effect on glycaemic control in type 2 diabetes. How often very simple surgical gastrointestinal interventions achieve sustained changes in energy and glucose homeostasis is of great research interest, and understanding is evolving rapidly. The effect of weight loss appears critical to both short and longer term outcomes and evidence supporting this will be provided. However, there are some clear effects beyond weight loss with some specific anatomical arrangements that are elements of some surgical procedures. The early remission of type 2 diabetes with Roux-en-Y gastric bypass has been of particular interest and a growing array of gastrointestinal changes generated by this procedure is now evident, and many of these changes may influence glucose homeostasis. While very exciting some caution is recommended as the durability of beyond ‘weight loss’ effects is unclear, and there are issues in translating rodent experimental data to humans. The role of the gut in glucose homeostasis is becoming clearer and could provide insights into the pathogenesis of type 2 diabetes and assist in the development of new procedures, devices and drugs both for obese and non-obese patients.
Garvan Institute of Medical Research and St Vincent’s Hospital, Darlinghurst, NSW, Australia Body weight is one of the best predictors of bone density. Low body weight has been associated with low bone mass and increased fracture risk, and high body weight with high bone mass. Furthermore, weight loss has been associated with bone loss and osteoporotic fractures. The strong positive relationship between body weight and bone mass had largely been thought to be due to mechanical loading. However, this relationship is more complex than simple load bearing or the response of bone to muscle-induced strain. Adipocytes and osteoblasts originate from a common mesenchymal precursor and regulation of fat and bone cells appears to be more closely co-ordinated, through both central and peripheral pathways, than previously realised. Moreover, recent data suggest that obesity may not confer the protective effect against fracture as was once thought, with higher than expected prevalence of fractures in obese children and adults. Bariatric surgery is associated with significant weight loss and some types of surgery, specifically Roux-en-Y gastric bypass surgery has been associated with significant bone loss although this does not appear to be the case with gastric banding. Data on gastric sleeve surgery, growing in popularity in Australia, is limited. However, the degree of weight loss and many of the gut hormonal responses following gastric sleeve surgery are similar to gastric bypass, presenting the possibility that bone health may be adversely affected following this type of surgery. This talk will discuss some of the complexities surrounding the bone—fat relationship, the available data on bone density and fracture following different types of bariatric surgery as well as present some recent data from a current study
http://dx.doi.org/10.1016/j.orcp.2013.12.523