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Risk factors for secondary hyperparathyroidism after bariatric surgery: a comparison of 4 different operations and of vitamin D-receptor-polymorphism.

AbstractOBJECTIVE:
To determine the relative frequency of secondary hyperparathyroidism after 1 of 4 standard bariatric surgical procedures, with respect to vitamin D-receptor (VDR) Bsm1 genotype-polymorphism (VDRP).
METHODS:
Included were 141 obese men and women [aged 44.6±10.4 years, body mass index (BMI) 44.4±5.4 kg/m²], who had undergone either gastric banding (GB; n = 39), laparoscopic sleeve-gastrectomy (LSG; n = 31), Roux-en-Y-gastric-bypass (RYGB; n=43), or biliopancreatic-diversion with "duodenal switch" (BP-DS; n = 28)]. They were tested for VDR-genotype (Bsm1), vitamin D, and serum-PTH-levels postoperatively.
RESULTS:
Analysis of Covariance revealed a treatment effect, showing statistically significantly higher PTH-levels after BP-DS than after GB (mean difference = 32.14, p<0.001), after SG (mean difference = 25.18, p=0.001), or after RYGB (mean difference = 18.15, p=0.020). VDR-BSM1-genotype did not influence PTH-levels and vitamin-D postoperatively. Logistic regression indicated that the risk of developing SHPT after BP-DS was 12.5 times higher than after GB and 16.7 times higher than after SG. Beside other variables, VDR-genotype and the interaction between VDR-genotype and type of surgery did not attain statistical significance.
CONCLUSIONS:
In a comparison of the 4 most frequently performed bariatric operations vitamin-D-receptor polymorphism (VDRP) had no influence on the development of postoperative secondary hyperparathyroidism (SHPT) and is not useful as a predictor. SHPT occurs most often after BP-DS. Operation type, gender, VDRP, preoperative BMI, and relative postoperative BMI-loss, however, only explain 24% of the variance in postoperative PTH levels. Other gastral or intestinal factors physiologically promoting calcium-turnover and PTH regulation are postulated.
AuthorsP Toelle, R Peterli, I Zobel, C Noppen, C Christoffel-Courtin, T Peters
JournalExperimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association (Exp Clin Endocrinol Diabetes) Vol. 120 Issue 10 Pg. 629-34 (Nov 2012) ISSN: 1439-3646 [Electronic] Germany
PMID23073920 (Publication Type: Comparative Study, Journal Article)
Copyright© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.
Chemical References
  • PTH protein, human
  • Parathyroid Hormone
  • Receptors, Calcitriol
  • VDR protein, human
  • Vitamin D
Topics
  • Adult
  • Bariatric Surgery (adverse effects, methods)
  • Biliopancreatic Diversion (adverse effects, methods)
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Genetic Association Studies
  • Humans
  • Hyperparathyroidism, Secondary (epidemiology, etiology, genetics, metabolism)
  • Incidence
  • Male
  • Middle Aged
  • Mutation
  • Parathyroid Hormone (blood)
  • Postoperative Complications (epidemiology, etiology, genetics, metabolism)
  • Postoperative Period
  • Receptors, Calcitriol (genetics, metabolism)
  • Retrospective Studies
  • Risk Factors
  • Switzerland (epidemiology)
  • Vitamin D (blood)

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