代谢手术影响骨代谢的机制研究

Mechanism study of effects of metabolic surgery on bone metabolism

代谢手术是目前治疗肥胖症的有效方法,但其引起的骨密度降低,甚至骨质疏松已受到广泛关注,是亟待解决的问题.代谢手术的作用包括改变胃肠道结构,影响钙、维生素D的吸收,导致骨骼中钙盐沉积减少,直接降低骨密度,同时可引起甲状旁腺激素升高,导致继发性甲状旁腺功能亢进症,以及术后骨质疏松发病率的升高;升高肽YY水平,降低ghrelin水平,从而抑制成骨细胞增殖,促进破骨细胞活动及骨吸收,抑制骨形成,降低骨密度;减少脂肪组织,降低瘦素水平,使骨吸收增加,骨形成减少,骨密度降低,增加骨质疏松甚至骨折风险;升高胰高血糖素样肽-1（GLP-1）与脂联素水平,促进成骨活动;降低雌二醇水平,升高性激素结合球蛋白、游离睾酮、促性腺激素水平,作用于成骨细胞,影响骨代谢;改变相关骨代谢标志物.外源性补充维生素D、钙剂甚至GLP-1受体激动剂可保护骨密度,从而预防骨质疏松.

Metabolic surgery is an effective method for the treatment of obesity.The reduction of bone mineral density caused by metabolic surgery has received extensive attention and become an urgent problem need to be tackled.The effects of metabolic surgery include altering gastrointestinal structure and decreasing absorption of calcium and vitamin D, leading to reduced bone calcium salt deposition, decreasing bone mineral density, resulting in secondary hyperparathyroidism and more postoperative incidence of osteoporosis.The increased level of peptide YY, and the decreased level of ghrelin, which could inhibit the proliferation of osteoblasts, promote osteoclast activity and bone resorption, resulting in inhibition of bone formation and reduction of bone density.The decrease of the adipose tissue and the leptin level could increase bone resorption, decrease bone formation and bone density, which may increase the risk of osteoporosis even fracture.After the operation, the levels of adiponectin and glucagon-like peptide 1 （GLP-1） were increased,which could promote the osteogenic activity.After metabolic surgery, estradiol levels decreased, sex hormone-binding globulin, free testosterone and gonadotropin levels increased, which could directly affect osteoblasts and bone metabolism.Metabolic surgery can also lead to changes in bone turnover markers.Bone mineral density can be protected by exogenous vitamin D, calcium and even GLP-1 agonists, therefore osteoporosis could be prevented.