Skelettale Auswirkungen bariatrischer Chirurgie

Zusammenfassung

Bei zunehmender Prävalenz der Adipositas sind in Deutschland ca. 54% der Bevölkerung übergewichtig oder adipös, wobei mit steigendem Übergewicht das Risiko für weitere Erkrankungen, wie z. B. Diabetes mellitus Typ 2, Herzinsuffizienz, arterielle Hypertonie u. a. stark ansteigt. Die Reduktion des Körpergewichtes ist daher aus verschiedenen Gesichtspunkten anzustreben. Viele Patientinnen und Patienten mit Adipositas haben bereits vor einer möglichen Operation einen Mangel an Vitamin D und Calcium und zeigen in Laboruntersuchungen entsprechende Defizite. Die konservative Behandlung der Adipositas aus Ernährungs-, Bewegung- und Verhaltenstherapie bildet die Basis der möglichen Therapiemaßnahmen. Bei Versagen der konservativen Behandlungsoptionen ergibt sich ab einem Body-Mass-Index (BMI) von über 40 kg/m2 die Indikation zur operativen Therapie, ab einem BMI von 50 kg/m2 besteht unter bestimmten Voraussetzungen die primäre Indikation zur Durchführung einer bariatrisch-chirurgischen Maßnahme. Zu den in Deutschland am häufigsten empfohlenen operativen Verfahren, die in der Regel laparoskopisch durchgeführt werden, gehören weiterhin die Implantation eines Magenbands, die Bildung eines Magenschlauchs (Gastric-sleeve-Resektion), die Anlage eines proximalen Roux-en-Y-Magenbypass oder eines Omega-loop-Magenbypass. Neben der angestrebten Reduktion des Übergewichtes durch ihre restriktiven wie malabsorptiven Wirkungen führen diese OP-Methoden in unterschiedlichem Ausmaß zu Veränderungen des Kalzium-Stoffwechsels u. a. mit Hypocalcämie, Vitamin-D-Defizit und Erhöhung des Serum-Parathormons, was in einem erhöhten Frakturrisiko, Veränderungen der Knochendichte und der Mikroarchitektur des Knochens münden kann. In der Nachsorge nach bariatrischen Operationen sind daher eine ausreichende Supplementierung verschiedener Vitamine, Mineralien und Spurenelemente, die regelmäßige Kontrolle der Laborparameter und der Knochendichte sowie ein angepasstes körperliches Training wichtig. Aus osteologischer Sicht kommt bei diagnostizierter Osteoporose insbesondere eine intravenöse antiresorptive Therapie in Betracht.

Abstract

The prevalence of obesity is increasing. In Germany, about 54% of the population is obese. With increasing obesity, the risk of other diseases, such as diabetes mellitus type 2, heart failure, arterial hypertension, etc. increases sharply. The reduction of excessive body weight should therefore be aimed at from various points of view. Many obese patients already present with laboratory detectable vitamin D deficiency and hypocalcemia before a potential operation. A conservative therapy approach consisting of nutritional, physical and behavioural treatment forms the basis for any treatment. Under several conditions – e. g., if the patient’s body-mass-index (BMI) exceeds 40 kg/m2 and conservative therapy has failed or if the primary BMI measures above 50 kg/m2 – surgical therapy may be indicated. Possible surgical procedures recommended in Germany are gastric-banding, sleeve-gastrectomy, proximal Roux-en-Y gastric bypass, and omega-loop gastric bypass. These surgical methods result in changes of bone metabolism with potential hypocalcaemia, vitamin D deficiency, increased serum levels of parathyroid hormone, increased fracture risk, and changes in both density and microarchitecture of the bone. In follow-up care after bariatric surgery, adequate supplementation of vitamins, minerals and trace elements, regular monitoring of laboratory parameters and bone density as well as adapted physical training are important components.

Schlüsselwörter

Knochenstoffwechsel - bariatrische Chirurgie - Osteoporose - Adipositas

Key words

bone metabolism - bariatric surgery - osteoporosis - obesity

Publication History

Received: 01 June 2022

Accepted: 25 July 2022

Article published online:
08 September 2022

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