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March 21, 2024

Pediatric Research Update | Bone Health Following Pediatric and Adolescent Bariatric Surgery: A Systematic Review and Meta-analysis

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Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses bone health following bariatric surgery in adolescents.

Bone Health Following Pediatric and Adolescent Bariatric Surgery: A Systematic Review and Meta-analysis

Article Summary

The authors present a review and metanalysis of papers concerning bone health after metabolic & bariatric surgery (MBS) in children and adolescents. They present an excellent discussion of the possible mechanisms and possible clinical ramifications. This review is a good example of looking for health improvements and/or complications after MBS.

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Article Review

The authors conducted a search and systematic review of studies reporting calcium and/or bone mineral density in patients less than 18 years old who underwent metabolic and bariatric surgery (MBS). Results included 12 studies meeting search criteria, involving 681 patients. The authors found MBS to be successful in assisting the children in achieving significant reduction of weight measured by body mass index (BMI). Regarding bone health, results found the bone mineral density went down in patients who underwent the MBS procedures of sleeve gastrectomy and Roux-en-Y gastric bypass (RYGB). In contrast, markers of bone resorption went up with sleeve gastrectomy and RYGB. Neither of these findings was true for patients who used the MBS procedures of adjustable gastric bands or intra-gastric balloons to reduce their weight and BMI.

The authors provide an interesting and informative discussion of the possible mechanisms of these results, the chance for spontaneous resolution of the possibly deleterious changes in the bone density over time, and the lack of evidence of the clinical significance of these findings about bone density over time.

The authors’ work is very important as we move to an era where we have an increasing array of tools that consistently and durably lead to significant change in body composition and improvement in health for children with the disease of obesity. The parameters we use to follow these patients need to be focused on their health and on possible complications of the therapy. The new tools for treatment of the disease of obesity do have risks and their risk-benefit ratio over time is of utmost importance as clinicians engage with the patient and family using shared decision making regarding treatment options. When these principles are applied to children with the disease of obesity, the child’s growth and development as well as their long lifespan need to be taken into consideration. Mitra and colleagues have added to a new world of literature about the disease of obesity where the parameters of weight, BMI, BMI percentile, waist circumference, and waist-hip ratio will be replaced by more physiological parameters such as body composition, bone density, and location and type of different types of adipose tissue.

Mitra AT, Das B, Sarraf KM, Ford-Adams M, Fehervari M, Ashrafian H. Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis. EClinicalMedicine. 2024;69:102462. Published 2024 Feb 2. doi:10.1016/j.eclinm.2024.102462

Article reviewed by:

Allen Browne Headshot


Dr Browne is a retired pediatric surgeon and pediatric obesity medicine physician. He now focuses on education about the disease of obesity and obesity as a disease and is an advocate for children with the disease of obesity and their families.