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Cited by 82Bariatric Surgery and OutcomesParathyroid Disorders and TreatmentsThyroid and Parathyroid Surgery

Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women

Youssef, Y., Richards, W. O., Sekhar, N., Kaiser, J., Spagnoli, A., Abumrad, N., Torquati, A.·2007·Surgical Endoscopy
DOI 10.1007/s00464-007-9228-6
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Abstract

Background Metabolic bone disease is a potential complication of bariatric surgery. The aims of our study were to evaluate the effects of laparoscopic gastric bypass on calcium and vitamin D metabolism, and to identify patients at high risk to develop secondary hyperparathyroidism (HPT).Methods Serum calcium, alkaline phosphatase, intact parathyroid hormone (PTH), and 25-hydroxy (OH) vitamin D were measured at 3, 6, 12, and 24 months after laparoscopic gastric bypass in a cohort of morbidly obese women. Logistic regression was used in both univariate and multivariate models to identify independent preoperative variables associated with secondary HPT.Results The study enrolled 193 morbidly obese women. During the 2-year follow-up period, the incidence of elevated PTH levels (>65 pg/ml) was 53.3%. The mean time elapsed between surgery and detection of secondary HPT was 9.1 months (range, 3-24 months). Vitamin D deficiency was observed in 39 patients (20.2%). On univariate analysis, the preoperative factors associated with secondary HPT were race (high PTH levels were detected in 70% of African Americans versus 50% of Caucasians; p < 0.05), preoperative body mass index (BMI; high PTH: 52.5 +/- 10.8 versus normal PTH: 48.9 +/- 7.5 kg/m2; p < 0.01), and age (high PTH: 44.9 +/- 9.2 versus normal PTH: 42.3 +/- 9 years, p < 0.05). Race and age remained independent risk factors for secondary HPT in the multivariate logistic regression model after adjusting for the covariate Roux-limb length. African Americans were at more than 2.5 times greater risk to develop secondary HPT as Caucasian (RR 2.5; 95% CI: 1.03-6.17, p < 0.05). Patients older than 45 years were at 1.8 times higher risk of developing secondary HPT as their younger counterparts (RR 1.8; 95% CI: 1.01-3.32, p < 0.05).Conclusions Morbidly obese women have a high incidence of elevated PTH levels after gastric bypass surgery. Low vitamin D levels did not constitute the only reason behind this finding. African-American women and women older than 45 years of age were at significantly higher risk of developing secondary HPT. In these populations, aggressive supplementation with calcium citrate and vitamin D should be implemented.

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  • Calcium malabsorption has been documented as early as 3 months after RYGB, with reduced true fractional calcium absorption and secondary hyperparathyroidism.

    “Calcium malabsorption has been documented as early as 3 months after RYGB53, 54 with reduced true fractional absorption of calcium57, and secondary hyperparathyroidism52, 53, 58, 59.”

    From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [59]

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Authors
Youssef, Y., Richards, W. O., Sekhar, N., Kaiser, J., Spagnoli, A., Abumrad, N., & Torquati, A.
Affiliations
Vanderbilt University (US)
Corresponding author
Torquati, A.
ORCID
Venue
Surgical Endoscopy
Publisher
Springer Science and Business Media LLC
Published
2007-02-21
Volume
21
Issue
8
Pages
1393-1396
ISSN
  • 0930-2794 (ISSN-L)
  • 1432-2218
DOI
10.1007/s00464-007-9228-6
OpenAlex
W1987449086
Cited by
82
References
30
Citations by year
2026: 1 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 8 · 2017: 2 · 2016: 1 · 2015: 8 · 2014: 10 · 2013: 6 · 2012: 7
FWCI
8.63
Type
journal article
Language
en
Open access
closed
Licence
www.springer.com/tdm (tdm)
Locations
  • Surgical Endoscopy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
secondary hyperparathyroidism, laparoscopic gastric bypass, bariatric surgery, morbid obesity, women, vitamin D deficiency, parathyroid hormone, calcium metabolism, metabolic bone disease, risk factors, race, African Americans, body mass index, age, alkaline phosphatase, 25-hydroxyvitamin D, postoperative complications
MeSH terms
Adolescent, Adult, Alkaline Phosphatase, Calcium, Female, Humans, Hyperparathyroidism, Secondary, Middle Aged, Obesity, Morbid, Parathyroid Hormone, Laparoscopy, Vitamin D, Gastric Bypass

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