November 25, 2020 Your bones and type 2 diabetes

People with type 2 diabetes are at greater risk for developing fragile bones. The reasons for this are unclear, although research suggests it could be a combination of factors such as obesity and high blood sugar. For those who have bariatric surgery for weight loss, this risk increases. Certain procedures, such as Roux-en-Y [RYGB] and biliopancreatic diversion with duodenal switch [BPD/DS], can result in poor absorption of nutrients. It is unclear whether the most popular procedure, sleeve gastrectomy, results in an increased risk of fracture or adverse effects on bone. We talked to Dr. Claudia Gagnon, an endocrinologist, and a scientist at the CHU de Québec Research Centre, and Québec Heart and Lung Institute Research Centre in Quebec City, who is researching the benefits and risks of different bariatric surgeries.

Why is this research important?

Research shows that bariatric surgery is a better long-term solution for obesity than drugs and lifestyle, and can cure or improve type 2 diabetes. We think it will become a more common treatment for diabetes.

This is good—but it might not be so good for our bones, because the loss of muscle and changes in hormones during surgery can cause the bones to deteriorate. However, improving glycemic control or even curing diabetes after bariatric surgery may have beneficial effects on bone, but this has to be investigated.

What are you hoping to discover?

We will look at the impact of sleeve gastrectomy on bone health in people with or without type 2 diabetes, and the impact of improved or cured diabetes on the bone. We will also identify factors that influence bone health after sleeve gastrectomy, so we can act on them.

In sleeve gastrectomy, a large portion of the stomach is removed, so that a person will feel full after eating small amounts of food. With RYGB and BPD/DS procedures, the surgeon reduces the size of the stomach and connects it to the small intestine; the person will feel fuller with less food, and any swallowed food goes through the new passage, bypassing much of the stomach and small intestine, so fewer calories, and nutrients, are absorbed into the body.

How will your research affect people with diabetes and their health-care providers?

It will help providers to better inform patients about the impact of sleeve gastrectomy on the body's bones and give them more information before choosing this treatment. It will motivate patients to be more involved in their post-bariatric treatment. If certain exercise and supplements can improve recovery and reduce bone deterioration, patients [may] be more receptive to doing these things.

What is next for you on the research front?

Bone fragility is becoming a big issue in type 2 diabetes and is now recognized as a ‘microvascular complication,’ just like neuropathy [which affects nerve function]. I want to look at interventions that may decrease the effect of bariatric surgery on bone health, such as adding physical activity before surgery. I also want to evaluate the impact on bone health after certain bariatric procedures in which type 2 diabetes is improved or cured. 

How did you become interested in diabetes?

I wanted to be a gastroenterologist [a physician who deals with issues of the liver and gastrointestinal tract], but then I studied endocrinology [which focuses on glands and hormones] and realized this was exactly what I wanted to do. As part of my residency training, I was involved in a few research projects related to diabetes and obesity. I went to Australia to do a research fellowship where we looked at bone health, and how that is affected by obesity and diabetes. My first research project, funded by Diabetes Canada, was on the effect of high doses of vitamin D in reducing the risk of type 2 diabetes.

Dr. Claudia Gagnon at a glance

● Appointed associate professor in the Faculty of Medicine at Laval University (2018)

● Awarded Diabetes Canada New Investigator Award (2017)

● Published a research paper on fracture risk in BMJ (2016)

● Received the Young Investigator Award from the American Society for Bone and Mineral Research (2016)

● Completed a Fellowship in Metabolic Bone Diseases in Australia (2010)

● Earned her specialist certificate in endocrinology and metabolism (2006)

Visit Research to read about the research projects and awards funded by Diabetes Canada.

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(This article appeared in Diabetes Dialogue, Spring 2018)