Exercise Mitigates Bone Loss in Women With Severe Obesity After Roux-en-Y Gastric Bypass: A Randomized Controlled Trial

Author(s):Show less -

Murai, Igor H. ^[1] ; Roschel, Hamilton ^{[2, 1]} ; Dantas, Wagner S. ^[1] ; Gil, Saulo ^[1] ; Merege-Filho, Carlos ^[1] ; de Cleva, Roberto ^[3] ; De Sa-Pinto, Ana L. ^[2] ; Lima, Fernanda ^[2] ; Santo, Marco A. ^[3] ; Benatti, Fabiana B. ^{[1, 4]} ; Kirwan, John P. ^[5] ; Pereira, Rosa M. ^[2] ; Gualano, Bruno ^{[2, 1]}

Affiliation

^[1] Univ Sao Paulo, Appl Physiol & Nutr Res Grp, Lab Assessment & Conditioning Rheumatol, Sch Phys Educ & Sport, Hosp Clin HCFMUSP, Fac Med F, BR-01246903 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med FMUSP, Rheumatol Div, BR-01246903 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Hosp Clin HCFMUSP, Fac Med FMUSP, Gastroenterol Dept, Digest Surg Div, BR-05409011 Sao Paulo - Brazil

^[4] Univ Estadual Campinas, Sch Appl Sci, BR-13484350 Campinas, SP - Brazil

^[5] Pennington Biomed Res Ctr, Integrat Physiol & Mol Metab Grp, Baton Rouge, LA 70808 - USA

• Document type: Journal article
• Source: JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM; v. 104, n. 10, p. 4639-4650, OCT 2019.
• Web of Science Citations: 0

Abstract

Context: Bone loss after bariatric surgery potentially could be mitigated by exercise. Objective: To investigate the role of exercise training (ET) in attenuating bariatric surgery-induced bone loss. Design: Randomized, controlled trial. Setting: Referral center for bariatric surgery. Patients: Seventy women with severe obesity, aged 25 to 55 years, who underwent Roux-en-Y gastric bypass (RYGB). Intervention: Supervised, 6-month, ET program after RYGB vs. standard of care (RYGB only). Outcomes: Areal bone mineral density (aBMD) was the primary outcome. Bone microarchitecture, bone turnover, and biochemical markers were secondary outcomes. Results: Surgery significantly decreased femoral neck, total hip, distal radius, and whole body aBMD (P < 0.001); and increased bone turnover markers, including collagen type I C-telopeptide (CTX), procollagen type I N-propeptide (P1NP), sclerostin, and osteopontin (P < 0.05). Compared with RYGB only, exercise mitigated the percent loss of aBMD at femoral neck {[}estimated mean difference (EMD), -2.91%; P = 0.007;], total hip (EMD, -2.26%; P = 0.009), distal radius (EMD, -1.87%; P = 0.038), and cortical volumetric bone mineral density at distal radius (EMD, -2.09%; P = 0.024). Exercise also attenuated CTX (EMD, -0.20 ng/mL; P = 0.002), P1 NP (EMD, -17.59 ng/mL; P = 0.024), and sclerostin levels (EMD, -610 pg/mL; P = 0.046) in comparison with RYGB. Exercise did not affect biochemical markers (e.g., 25(OH)D, calcium, intact PTH, phosphorus, and magnesium). Conclusion: Exercise mitigated bariatric surgery-induced bone loss, possibly through mechanisms involving suppression in bone turnover and sclerostin. Exercise should be incorporated in postsurgery care to preserve bone mass. (AU)

• FAPESP's process: 16/10993-5 - Effects of exercise training in patients undergoing bariatric surgery: a randomized and clinical trial
• Grantee: Hamilton Augusto Roschel da Silva
• Support Opportunities: Regular Research Grants
• FAPESP's process: 17/01427-9 - Molecular mechanisms involved in the extracellular matrix remodeling of skeletal muscle of obese patients undergoing bariatric surgery: role of insulin resistance and effects of exercise training
• Grantee: Wagner Silva Dantas
• Support Opportunities: Scholarships abroad - Research Internship - Doctorate
• FAPESP's process: 15/02833-5 - Effects of exercise training on bone parameters in patients subjected to bariatric surgery: a randomized controlled clinical trial
• Grantee: Igor Hisashi Murai
• Support Opportunities: Scholarships in Brazil - Doctorate