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RISEDRONATE USE TO ATTENUATE COMPARTMENTAL BONE LOSS FOLLOWING SLEEVE GASTRECTOMY: A PILOT RANDOMIZED CONTROLLED TRIAL

Abstract

Rebecca Knapp1, Katelyn Greene2, Ashley Weaver2, Ashlyn Swafford1, Jamy Ard2, Daniel Beavers2, Kristen Beavers1. 1Wake Forest University, Winston-Salem, NC. 2Wake Forest School of Medicine, Winston-Salem, NC.

Background: Sleeve gastrectomy (SG) is associated with bone mineral density (BMD) loss at the hip and spine, which may predispose patients to fracture. Bisphosphonates may be effective in mitigating SG-related bone loss. We previously showed that the bisphosphonate risedronate can blunt dual x-ray absorptiometry (DXA)-derived areal BMD loss among 24 SG patients. We extend those findings to examine quantitative computed tomography (QCT) derived volumetric BMD (vBMD) at cortical and trabecular compartments. Methods: The 6-month pilot study (NCT03411902) randomized 24 SG patients into once-monthly 150mg risedronate (n=11) or placebo (n=13) groups. Hip and spine QCT scans were performed at baseline, and 6- and 12-months post-SG to examine bone loss. Cortical and trabecular vBMD of total hip, femoral neck, and trochanter, and trabecular vBMD-only of lumbar spine (L1-L4) were quantified using QCTPro (Mindways Software, Inc., Austin, TX). Treatment effects of each outcome were estimated using a mixed linear model adjusted for baseline characteristics. Results: Baseline average age was 55.7±6.7 years and BMI was 44.7±6.3 kg/m2. 83% of participants were women (62.5% postmenopausal). Weight loss at the 6-month mark was -16.3 kg (-20.0, -12.5) for the risedronate group and -20.9 kg (-23.7, -18.1) for the placebo group. No significant differences were observed in vBMD outcomes between groups at 6- or 12-months. However, 6-month trends show reduced trabecular vBMD (mg/cc) loss at the total hip [-5.6 (-15.2, 4.0) vs -9.0 (-15.8, -2.1)], and femoral neck [3.7 (-8.8, 16.1) vs -5.6 (-14.4, 3.2)] following risedronate vs placebo use. In contrast, the placebo group experienced greater increases in cortical bone than the risedronate group at the total hip [13.9 (2.3, 25.5) vs -0.9 (-18.6, 16.9)] and femoral neck [15.7 (-6.6, 37.9) vs -15.4 (-47.5, 16.7)]. No general trends were observed at the spine. Conclusion: Results do not indicate that risedronate significantly affects vBMD change at the hip and spine among SG patients. However, differential trends in trabecular and cortical compartments warrant further study.

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