BMJ 2014;349:g6190 doi: 10.1136/bmj.g6190 (Published 14 October 2014)
Page 1 of 1
Letters
LETTERS BARIATRIC SURGERY FOR OBESITY
Authors’ reply to Laurent 1
David Arterburn associate investigator , Anita Courcoulas professor of surgery
2
Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA; 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA 1
Laurent urges bariatric surgeons to liaise with local metabolic bone disease experts and review their follow-up, treatment, and referral protocols regarding the management of calcium malabsorption, osteomalacia, and osteoporosis after bariatric procedures.1 2 We agree and further urge all physicians who care for patients who have undergone bariatric surgery to carefully review the joint clinical practice guidelines issued in 2013 by the American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery.3 These guidelines encourage providers to prescribe calcium citrate 1200-1500 mg/day and vitamin D, at least 3000 units/day (titrated to >30 ng/mL), postoperatively for all patients who undergo bariatric surgery (table 6 in the guidelines). Furthermore, these guidelines suggest that a comprehensive metabolic panel (serum calcium, phosphorus, and alkaline phosphatase) is measured at each visit after surgery. Other recommended tests include 24 hour urine calcium excretion at six months, then annually, after surgery, and bone density at two years after surgery, as well as measurement of 25-vitamin D and intact parathyroid hormone in patients who have undergone Roux-en-Y gastric bypass or biliopancreatic diversion
with duodenal switch. These steps should help to ensure that patients with metabolic bone disease are detected early and treated appropriately. Competing interests: Both authors declare no support from any organisation for the submitted work; DA reports grants from National Institutes of Health, grants and non-financial support from Informed Medical Decisions Foundation, grants from Department of Veterans Affairs, and grants from Agency for Healthcare Research and Quality outside the submitted work. AC reports other funding from J&J Ethicon Scientific, personal fees from J&J Ethicon Scientific, grants from NIH-NIDDK, grants from Covidien, grants from EndoGastric Solutions, and grants from Nutrisystem outside the submitted work. 1 2 3
Laurent MR. Bariatric surgery: give more weight to bone loss. BMJ 2014;349:g6189. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 2014;349:g3961. (27 August.) Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Endocr Pract 2013;19:337-72.
Cite this as: BMJ 2014;349:g6190 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Letters
LETTERS BARIATRIC SURGERY FOR OBESITY
Authors’ reply to Laurent 1
David Arterburn associate investigator , Anita Courcoulas professor of surgery
2
Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA; 2University of Pittsburgh Medical Center, Pittsburgh, PA, USA 1
Laurent urges bariatric surgeons to liaise with local metabolic bone disease experts and review their follow-up, treatment, and referral protocols regarding the management of calcium malabsorption, osteomalacia, and osteoporosis after bariatric procedures.1 2 We agree and further urge all physicians who care for patients who have undergone bariatric surgery to carefully review the joint clinical practice guidelines issued in 2013 by the American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery.3 These guidelines encourage providers to prescribe calcium citrate 1200-1500 mg/day and vitamin D, at least 3000 units/day (titrated to >30 ng/mL), postoperatively for all patients who undergo bariatric surgery (table 6 in the guidelines). Furthermore, these guidelines suggest that a comprehensive metabolic panel (serum calcium, phosphorus, and alkaline phosphatase) is measured at each visit after surgery. Other recommended tests include 24 hour urine calcium excretion at six months, then annually, after surgery, and bone density at two years after surgery, as well as measurement of 25-vitamin D and intact parathyroid hormone in patients who have undergone Roux-en-Y gastric bypass or biliopancreatic diversion
with duodenal switch. These steps should help to ensure that patients with metabolic bone disease are detected early and treated appropriately. Competing interests: Both authors declare no support from any organisation for the submitted work; DA reports grants from National Institutes of Health, grants and non-financial support from Informed Medical Decisions Foundation, grants from Department of Veterans Affairs, and grants from Agency for Healthcare Research and Quality outside the submitted work. AC reports other funding from J&J Ethicon Scientific, personal fees from J&J Ethicon Scientific, grants from NIH-NIDDK, grants from Covidien, grants from EndoGastric Solutions, and grants from Nutrisystem outside the submitted work. 1 2 3
Laurent MR. Bariatric surgery: give more weight to bone loss. BMJ 2014;349:g6189. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 2014;349:g3961. (27 August.) Mechanick JI, Youdim A, Jones DB, Garvey WT, Hurley DL, McMahon MM, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic and Bariatric Surgery. Endocr Pract 2013;19:337-72.
Cite this as: BMJ 2014;349:g6190 © BMJ Publishing Group Ltd 2014
[email protected] For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
