Utilizing pQCT and Biomarkers of Bone Turnover to Study Influences of Physical Activity or Bariatric Surgery on Structural and Metabolic Status of Bone

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Virginia Tech

Bone health in the context of two common maladies, osteoporosis and obesity, has spurred research in the area of physical activity (PA) and bariatric surgery (BarS).

Objectives: To examine: 1) relationships between PA and the skeleton utilizing the peripheral Quantitative Computed Tomography (pQCT) and Dual-energy X-ray Absorptiometry (DXA) in pre-menopausal women; 2) effects of adjustable gastric banding (AGB) vs. Roux-en-Y gastric bypass (RYGB) surgeries on pQCT and DXA measures; 3) 6-month time course changes on serum biomarkers of bone turnover and associated adipokines induced by AGB vs. RYGB.

Methods: Standard DXA and pQCT measurements were taken for all subjects. PA tertiles (PA-L, PA-M, PA-H) were based on a calculated average MET-min/day determined from 4-d self-reported PA and pedometer step counts. For BarS subjects, bone measurements were taken pre-surgery, 3- and 6-months post-surgery along with serum (or plasma) from fasting blood draws, with ELISA assays for total OC, undercarboxylated OC, CTx, adiponectin, and leptin.

Results: Minimal DXA differences between the highest and lowest PA tertiles were seen, while pQCT tibial measures and polar strength-strain index (SSIp) indicated differences along the tibial shaft. Comparing the two instruments and adjusting for BMI, the DXA leg and hip BMD and BMC showed differences (p<0.05) between PA-M and PA-L as well as PA-H and PA-L. Similarly, the pQCT tibial cortical area, BMC, and SSIp were progressively greater for the different levels of PA (p<0.05). 3- and 6-months post-BarS weight, fat-free mass, fat mass, central body fat, tibial and radial subcutaneous fat, and radial MCSA decreased (p<0.05). Comparing the AGB and RYGB and adjusting for weight, DXA BMC showed decreases (p<0.01) at both time points for RYGB. RYGB demonstrated differences (p<0.05) in bone measures at 3- and 6-months post-surgery along the tibial shaft that are indicative of increases in bone strength, and at 6-months, total OC, undercarboxylated OC, and HMW adiponectin increased, while leptin decreased.

Conclusions: PA is associated with increases in bone, but pQCT data are more discriminatory and sensitive. 6-months post-RYGB, pQCT measures indicate increases in bone strength parameters, and greater bone adaptation was evidenced by biomarkers of increased osteoblastic activity.

Physical Activity, Bariatric Surgery, Bone, peripheral Quantitative Computed Tomography, pQCT