Clinical Outcomes Research

Kothari-Bilek SAGES Collaboration: Feasibility of Bisphosphonate use on Sleeve Gastrectomy Associated Bone Loss: Healthy Body, Healthy Bones Trial

Fragility fractures of the hip and spine are among the leading causes of morbidity in older adults, compromising both quality and expectancy of life. With most fragility fractures occurring in overweight or obese individuals, it is important to evaluate and prevent contributing factors leading to increased fracture risk in this population. Bariatric surgery is an increasingly utilized and effective treatment for obesity and obesity related comorbidities, however, surgery associated weight loss can adversely affect bone metabolism and bone mineral density, leading to increased risk of clinically relevant fractures.

Bariatric surgery has been associated with cortical bone loss, a nearly 10% decrease in bone mineral density and an elevation in bone turnover markers (sclerostin, CTX, and P1NP) immediately after surgery and for up to two years post-surgical treatment. Alarmingly, emerging long-term data suggest that bone loss continues in these patients even after weight stabilizes. Bone loss is an unintended consequence of an otherwise life-saving procedure in many cases, with declining bone health potentially contributing to major morbidity in those undergoing a bariatric procedure.

There are many well-studied therapeutic options for combating bone loss, including the use of bisphosphonates such as zoledronic acid. Bisphosphonates have been well studied for safety and efficacy in the treatment of low bone density in non-surgical populations, but whether these pharmacotherapies are beneficial to patients after surgical weight loss procedures remains to be determined. We hypothesize that zoledronic acid, a well-established treatment for low bone density, will be an effective intervention to reduce sleeve gastrectomy (SG) induced bone loss.

Investigators:  PIs: Vishal Kothari, MD (UNMC-Surgery), Laura Bilek, PT, PhD (UNMC-COPH)

Funding Source:  SAGES 2019 Research Award


Tanner Collaboration: Impact Study: Influence of Maternal Post-Operative Weight Loss on Adolescent Children and Teens Using the Family Connections Program

Obesity is responsible for escalating rates of type 2 diabetes, hypertension, cardiovascular disease, sleep apnea, bone and joint disorders, cancer, and reduced life expectancy for the current generation of children. More than 30% of children between 6 and 19 years old are considered overweight or obese. According to the United Health Foundation’s America’s Health Rankings, Nebraska has a 31.4% rate of obesity, putting it 37th out of the 50 States in rates of obesity. Obesity is a multifactorial disease, is often familial and multi-generational, and studies have shown that parental obesity is one of the most important predictors of childhood obesity. A child has a 48% chance of becoming overweight or obese if one parent is obese. There are various ways to treat obesity, including behavioral modifications, increasing physical activity, or bariatric (weight-loss) surgery. Successful treatment often involves using more than one of these options. Both genetic and environmental factors are known to play a role in childhood obesity, and environmental risk factors offer a potential target focus for intervention in the at-risk child population.

This study proposes to examine if weight loss in mothers translates to better weight management in their children. In preparation, and as follow-up for weight-loss surgery, the Nebraska Medicine Bariatric Center offers patients counseling in improved dietary management, methods to increase physical activity, and psychological support. Each bariatric surgical patient receives consultation with a dietician, psychologist, and an exercise physiologist. We propose that mothers enrolled in the surgical weight loss program bring their children to attend these consultations with the specialists. Mothers and children enrolled in the study will have their height, weight, and physical activity assessed at pre-operative and postoperative study visits. Study subjects will also complete questionnaires of their self-reported physical activity and eating habits at these study visits. The goal of this pilot study is to examine whether this behavioral intervention will have an impact on the overall health and weight of children whose mothers have received bariatric surgery.

Investigators:  PIs: Tiffany Tanner, MD (UNMC-General Surgery), Fabio Almeida, PhD (UNMC-COPH), Fabiana Silva, PhD (UNMC-COPH)