Changes in Bone Mineral Density After Weight Loss Due to Metabolic Surgery or Lifestyle Intervention in Obese Patients
Changes in Bone Mineral Density After Weight Loss Due to Metabolic Surgery or Lifestyle Intervention in Obese Patients
复制标题
肥胖患者因代谢手术或生活方式干预而减肥后骨矿物质密度的变化
DOI：
10.1007/s11695-020-05095-x
复制
发表时间：
2020-11-03
期刊：
影响因子：
2.9
通讯作者：
Zhou, Zhiguang
中科院分区：
文献类型：
--
作者：
Chen, Xi;Zhang, Jingjing;Zhou, Zhiguang
目的代谢外科手术和生活方式干预是治疗肥胖症的两种常用方法，但减肥对骨密度的影响仍存在争议。我们的目的是评估新陈代谢手术或生活方式干预导致的体重减轻后全髋关节、股骨颈和腰椎骨密度的变化。材料和方法检索PubMed、Web of Science和Cochrane图书馆，检索2020年8月5日之前发表的相关研究。提取主要结果，包括代谢性手术或生活方式干预前和12个月后的全髋关节、股骨颈和腰椎的骨密度。结果共纳入19项研究，1095名肥胖者。其中，603名肥胖患者接受代谢手术，492名接受生活方式干预。减肥12个月后，肥胖患者全髋部骨密度显著下降(平均差值0.06g/cm(2)；95%可信区间[CI]0.03~0.08；I-2=67%；P<；0.001)，而腰椎骨密度无明显变化(P>；0.05)。在亚组分析中，接受代谢手术的肥胖患者在12个月时股骨颈骨密度显著下降(MD=0.08g/cm(2)；95%可信区间0.04~0.13；I-2=84%；P<；0.001)，而接受生活方式治疗的肥胖患者股骨颈骨密度无显著变化(P>；0.05)。结论无论是代谢性手术还是生活方式治疗，肥胖患者减重后全髋部骨密度均显著降低。不同的减肥方法对股骨颈骨密度的影响可能不同。前瞻性研究，最好是随机对照试验(RCT)，仍然需要调查这两种治疗方法对骨代谢的影响是否真的不同。
Purpose Metabolic surgery and lifestyle intervention are two common methods used to treat obesity, but the effects of weight loss on bone mineral density (BMD) remain controversial. Our aim was to evaluate changes in BMD of the total hip, femoral neck, and lumbar spine after weight loss caused by metabolic surgery or lifestyle intervention. Materials and Methods We searched PubMed, Web of Science, and the Cochrane Library to identify relevant studies published before 5 August 2020. The primary outcomes, including the BMD of the total hip, femoral neck, and lumbar spine before and 12 months after metabolic surgery or lifestyle intervention, were extracted. Results A total of 19 studies with 1095 participants with obesity were included. Among them, 603 participants with obesity accepted metabolic surgery, while 492 accepted lifestyle intervention. At 12 months after weight loss, the BMD of the total hip decreased significantly in obese patients (mean difference [MD] = 0.06 g/cm(2); 95% confidence interval [CI] 0.03 to 0.08; I-2 = 67%; P < 0.001), while the BMD of the lumbar spine did not significantly change (P > 0.05). In the subgroup analysis, the BMD of the femoral neck decreased significantly at 12 months in obese patients who underwent metabolic surgery (MD = 0.08 g/cm(2); 95% CI 0.04 to 0.13; I-2 = 84%; P < 0.001), while it did not significantly change in obese patients who underwent lifestyle treatment (P > 0.05). Conclusion Regardless of whether the patients underwent metabolic surgery or lifestyle treatment, the BMD of the total hip significantly decreased in obese patients after weight loss. Different methods used to lose weight may have different effects on the BMD of the femoral neck. Prospective studies, preferably randomized controlled trials (RCTs), are still required to investigate whether the effects of the two treatments on bone metabolism are truly different.