Endocrine Abstracts

Obesity management often needs significant weight loss, which can be achieved through bariatric surgery or pharmacologic therapies. This study compared the short-term impact of Roux-en-Y Gastric by pass surgery (RYGB) versus Pharmacologic therapy with liraglutide (GLP 1 A) on bone mineral density (BMD) and fracture risk in patients with severe obesity.

Methods: A 6-month prospective observational study from was conducted in 60 adults with BMI ≥35 kg/m2. Study participants were allocated into two groups: Surgery (RYGB, n = 30) and Pharmacotherapy (liraglutide 3.0 mg/day, n = 30 mg/day, n = 30). patients were followed over 6 months and along with prospective weight loss lumbar spine and femoral neck BMD were assessed by DEXA at baseline, 12, and 24 weeks. Serum markers of bone turnover (CTX, PINP) and fracture risk (FRAX score) were evaluated alongside weight changes.

Results: The surgical group achieved greater weight reduction (-22.5 kg) compared to pharmacotherapy (-10.2 kg). However, RYGB was associated with a more pronounced decline in hip BMD (-4.8% vs. -1.2%) and spine BMD (-2.5% vs. -1.5%). Bone turnover markers showed a marked rise in resorption (CTX +65%) post-surgery, whereas liraglutide was associated with significant suppression of both CTX (0.65→0.10 ng/mL) and PINP (0.25→0.05 ng/mL), with a greater relative decline in resorption. The FRAX score increased more in the surgical group (+1.5), indicating higher fracture risk.

Conclusion: RYGB provides greater weight loss but carries a greater risk of bone loss and increased fracture risk compared to pharmacologic therapy. Liraglutide shows a more bone-sparing profile, suggesting it may be preferable for patients at risk of osteoporosis. Long-term follow-up is guaranteed to confirm these findings.

Key works: CTX - C telopeptide, PINP (pro collagen type 1 pro peptide), DEXA (dual Xray energy bone absorptiometry), FRAX (fracture risk assessment tool)