OBJECTIVE To determine mechanisms contributing to impaired bone health in youth 24 months following sleeve gastrectomy (SG). DESIGN Twenty-four-month longitudinal observational study. METHODS Participants included 23 youth undergoing SG and 30 non-surgical controls (NS) 13-25 years old with moderate-to-severe obesity. Subjects underwent fasting labs for bone turnover markers (N-terminal propeptide of type 1 procollagen, C-telopeptide (CTX)), sex hormones, sex hormone binding globulin (SHBG), and enteric peptides, DXA for areal bone mineral density (aBMD) and body composition, high-resolution peripheral quantitative CT for volumetric BMD (vBMD) at the distal radius and tibia, and microfinite element analysis for strength estimates. RESULTS Groups did not differ for mean age or BMI z-scores. Over 24 months, compared to NS, SG had greater reductions in BMI z-scores, and spine, hip, and femoral neck aBMD Z-scores (P ≤ .012), greater increases in serum CTX and SHBG (P ≤ .039), and greater decreases in estrone and ghrelin (P ≤ .021). Among females, estrone and free androgen index (FAI) decreased (P ≤ .022) in SG vs NS groups. After controlling for age and sex, decreases in BMI and lean mass were associated with decreases in total hip and femoral neck aBMD Z-scores, and decreases in radial total and trabecular vBMD and failure load, and tibial total and trabecular vBMD. Among females, after controlling for age, decreases in estrone were associated with decreases in spine aBMD Z-scores and radial total and trabecular vBMD, and decrease in FAI with decreases in radial failure load. CONCLUSION Reductions in BMI, lean mass, and sex steroids over 24 months post-SG are associated with bone loss and could be targeted for preventative or therapeutic interventions. Clinical trial registration number: The study is registered in ClinicalTrials.gov (NCT02557438).

中文翻译：

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袖状胃切除术后骨骼的变化与体重和激素变化有关。

目的 确定袖状胃切除术 (SG) 后 24 个月导致青少年骨骼健康受损的机制。设计二十四个月的纵向观察研究。方法 参与者包括 23 名接受 SG 的青少年和 30 名 13-25 岁中度至重度肥胖的非手术对照组 (NS)。受试者接受禁食实验室检测骨转换标志物（1 型前胶原的 N 端前肽、C 端肽 (CTX)）、性激素、性激素结合球蛋白 (SHBG) 和肠肽、DXA 测定面积骨矿物质密度 (aBMD)和身体成分、用于远端桡骨和胫骨体积 BMD (vBMD) 的高分辨率外周定量 CT 以及用于强度估计的微有限元分析。结果 各组的平均年龄或 BMI z 分数没有差异。24 个月内，与 NS 相比，SG 的 BMI z 评分以及脊柱、髋部和股骨颈 aBMD Z 评分降低幅度更大 (P ≤ .012)，血清 CTX 和 SHBG 升高幅度更大 (P ≤ .039) ，雌酮和生长素释放肽的下降幅度更大 (P ≤ .021)。在女性中，SG 组与 NS 组相比，雌酮和游离雄激素指数 (FAI) 降低 (P ≤ .022)。控制年龄和性别后，体重指数和瘦体重的降低与全髋关节和股骨颈 aBMD Z 值的降低、桡骨总和小梁 vBMD 及破坏负荷、胫骨总和小梁 vBMD 的降低相关。在女性中，控制年龄后，雌酮的减少与脊柱 aBMD Z 分数、桡骨总和小梁 vBMD 的减少有关，并且 FAI 的减少与径向失效负荷的减少有关。结论 SG 治疗后 24 个月内 BMI、瘦体重和性类固醇的减少与骨质流失有关，可作为预防或治疗干预的目标。临床试验注册号：该研究已在 ClinicalTrials.gov 上注册 (NCT02557438)。