Effects of Roux-en-Y Gastric Bypass on Osteoclast Activity and Bone Density in Morbidly Obese Patients with Type 2 Diabetes

Laurel L. Tangalakis, Lawrence Tabone, Anna Spagnoli, Mike Muehlbauer, Philip Omotosho, Alfonso Torquati

Research output: Contribution to journalArticlepeer-review


Introduction: Roux-en-Y gastric bypass (RYGB) is a well-established treatment for morbid obesity and type 2 diabetes. The effects of RYGB on bone metabolism and bone health are largely unknown. Objective: Determine the changes in osteoclast function and bone density 1 year after RYGB as compared with a control group undergoing a diabetes support and education program (DSE). Design: A prospective cohort study with patients matched for weight and age assigned to RYGB or DSE. Setting: Large academic institution. Patients or Other Participants: Patients with type 2 diabetes mellitus and morbid obesity (body mass index greater than 35 kg/m2). Intervention: Subjects either received laparoscopic RYBG or DSE, which consisted of nutritional, exercise, and dietary counseling performed by a certified diabetic educator and a nutritionist three times over a year. Main Outcome Measure: Osteoclast activity, bone mineral density. Results: One year after, intervention subjects undergoing RYGB have a 280% increase in osteoclast activity as compared with a 7.6% increase in the DSE control group (P < 0.001). Furthermore, there was a statistically significant increase in sclerostin levels in subjects undergoing RYGB compared with an increase in the control group. The total bone mineral density was statistically unchanged within 1 year of intervention in both groups. A statistically significant decrease in bone mineral density in the left ribs (decrease of 6.8%, P < 0.05) and lumbar spine (decrease of 4.0%, P < 0.05) was seen 1 year after RYGB. Conclusions: There is a significant increase in osteoclast activity observed 1 year after RYGB; the long-term clinical implications of this increased bone metabolism are unknown.

Original languageEnglish (US)
Pages (from-to)290-295
Number of pages6
JournalObesity Surgery
Issue number1
StatePublished - Jan 1 2020


  • Bariatric surgery
  • Bone loss
  • Bone mineral density
  • Osteoclast
  • Roux-en-Y gastric bypass

ASJC Scopus subject areas

  • Surgery
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics

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