Exercise Programs Following Bariatric Surgery Could Help Protect Against Bone Loss

December 10, 2020
Patrick Campbell

Results from a randomized trial suggest engaging in an exercise program following weight loss surgery could help protect against bone loss.

Results of a recent study from investigators in Portugal suggest entering into an exercise program following weight loss surgery could help protect against bone loss.

Data from the trial, which included more than 75 patients undergoing weight loss surgery, suggested an exercise program composed of high-impact, balance, and resistance exercises was associated with higher bone mineral density measurements at lumbar spine and forearm compared to those not randomized to an exercise program.

"These findings showed that a structured exercise program may be a valid treatment option to minimize weight loss surgery-induced bone loss, which may be particularly important since many patients undergo surgery in early adulthood or even at pediatric ages," said lead investigator Florêncio Diniz-Sousa, MSc, of the University of Porto, in Portugal, in a statement. "As stated in recently released World Health Organization physical activity guidelines, regular exercise should be a priority for everyone, including patients who have undergone weight loss surgery."

With the prevalence and burden of obesity straining the public health system in countries throughout the world, the number of bariatric procedures has grown and is expected to grow moving forward. However, while data has demonstrated the benefits of bariatric surgery on diabetes remission and reduced risk of all-cause mortality in patients, gaps in care related to follow-up care of these patients is cause for concern among many clinicians.

Of these concerns, one of the most prevalent is the apparent increase in fracture risk after weight loss surgery. With this in mind, Diniz-Sousa and a team of colleagues sought to determine if exercise-training programs would have a beneficial effect on bone mass following gastric bypass or sleeve gastrectomy. In total, investigators identified a cohort of 84 patients who underwent one of the aforementioned procedures and these patients were randomized to an exercise intervention or a control group.

For those randomized to the exercise intervention, patients were enrolled in an 11-month supervised multicomponent exercise program beginning one month after bariatric surgery. Patient assessments were performed before surgery and again at months 1, 6, and 12 post-surgery. During these assessments, investigators obtained data related to patients' body composition, bone mineral density, bone turnover markers, calciotropic hormones, sclerotin, bone material strength index, muscle strength, and daily physical activity.

The primary outcome of the analysis was the between-group difference on lumbar spine bone mineral density cat 12 months after surgery. Investigators also noted secondary analyses were planned to further assess if any observed effects were dependent on training attendance.

Upon analysis, results indicated those in the exercise group had a higher bone mineral density at lumbar spine compared to the control group at 12 months (+0.024 g/cm; 95% CI, 0.004-0.044; P=.-15). In secondary analyses examining total hip, femoral neck, and 1/3 radius, only 1/3 radius bone mineral density improved in the exercise group versus the control group at 12 months (+0.013 g/cm; 95% CI, 0.003-0.023; P=.020).

Further analysis indicated there were no significant exercise effects observed on bone biochemical markers or material strength index. However, the exercise group had a higher lean mass (+1.5 kg; 95% CI, 0.1-2.9; P=.037) and higher number of high impacts (+51.4; 95% CI, 6.6-96.1; P=.026) when compared to the control group. Additionally, the secondary analysis suggested exercise-induced benefits could Abe obtained on femoral neck BMD but only in those attending 50% or more of the exercises (+5.3%; 95% CI, 2.0-8.6; P=.006).

This study, “The Effect of an Exercise Intervention Program on Bone Health After Bariatric Surgery: A Randomized Controlled Trial,” was published in the Journal of Bone and Mineral Research.