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High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures

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Abstract

Background

Bariatric surgery is an effective therapy for morbid obesity but may reduce calcium absorption and significantly decrease the bone mineral density. This study examined the prevalence of secondary hyperparathyroidism (SHPT) in obese subjects during follow-up after different bariatric surgeries. We investigated predictors of SHPT.

Methods

We enrolled 1470 obese subjects undergoing bariatric/metabolic surgery with at least 1-year follow-up, including 322 patients undergoing Roux-en-Y gastric bypass (RYGB), 695 undergoing single anastomosis (mini-) gastric bypass (SAGB), 93 undergoing laparoscopic adjustable gastric banding (LAGB), and 360 undergoing sleeve gastrectomy (SG). Five years of data were available for 215 patients. Patients were instructed to supplement their diet according to the guideline. Calcium, parathyroid hormone (PTH), and vitamin D levels were measured before surgery and at 1 and 5 years after surgery. SHPT was defined as PTH > 69 pg/mL.

Results

The overall prevalence of SHPT was high, 21.0% before surgery and was not different between patients with different bariatric procedures. Pre-operative PTH correlated with age, BMI, and vitamin D levels. Multi-variate analysis confirmed that vitamin D level was the only independent predictor of SHPT before surgery. The prevalence of SHPT increased to 35.4% at 1 year after surgery and 63.3% at 5 years after surgery. SAGB had the highest prevalence of SHPT (50.6%) followed by RYGB (33.2%), LAGB (25.8%), and SG (17.8%) at 1 year after surgery. At 5 years after surgery, SAGB still had the highest prevalence of SHPT (73.6%), followed by RYGB (56.6%), LAGB (38.5%), and SG (41.7%). Serum PTH at 1 year after surgery correlated with decreased BMI and weight loss. Multi-variate analysis confirmed that age, sex, calcium level, and bypass procedure were independent predictor of SHPT after surgery.

Conclusions

The prevalence of SHPT is high in morbidly obese patients before bariatric surgery which is related to vitamin D deficiency. The prevalence of SHPT increased continually along with the time after bariatric surgery, especially in patients receiving SAGB, followed by RYGB. The supplementation of vitamin D and calcium have to be higher in bypass procedure, especially in malabsorptive procedure.

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Funding

This work was supported by a grant obtained from Ming-Sheng General Hospital (2014-A-01).

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Authors and Affiliations

  1. Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan

    Jih-Hua Wei & Keong Chong

  2. Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan

    Jih-Hua Wei, Po-Hsun Huang & Shing-Jong Lin

  3. Department of Nutrition and Health Sciences, School of Healthcare Management, Kai-Nan University, Taoyuan, Taiwan

    Jih-Hua Wei

  4. Department of Surgery, Min-Sheng General Hospital, No. 168, Chin Kuo Road, Tauoyan, Taiwan, Republic of China

    Wei-Jei Lee & Shu-Chun Chen

  5. Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, Taiwan

    Yi-Chih Lee

  6. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan

    Po-Hsun Huang

  7. Division of Cardiovascular Medicine, Department of Internal medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Po-Hsun Huang & Shing-Jong Lin

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  1. Jih-Hua Wei
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Correspondence to Wei-Jei Lee.

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Wei, JH., Lee, WJ., Chong, K. et al. High Incidence of Secondary Hyperparathyroidism in Bariatric Patients: Comparing Different Procedures. OBES SURG 28, 798–804 (2018). https://doi.org/10.1007/s11695-017-2932-y

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  • DOI: https://doi.org/10.1007/s11695-017-2932-y

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