Prospective evaluation of metabolic bone disease after jejunoileal bypass.
Twenty-eight patients undergoing jejunoileal bypass for morbid obesity were studied prospectively for alterations in mineral metabolism and the development of metabolic bone disease. Eleven additional patients were examined for long-term complications. Serum 25-hydroxyvitamin D and fractional calcium absorption were depressed during the first 2 yr after bypass but normalized after this period. Serum parathormone remained normal. Mild osteomalacia was identified in 12% of subjects by histomorphometric analysis of undecalcified biopsy specimens. Osteomalacia was asymptomatic and could not be reliably diagnosed by noninvasive tests. Repeat biopsies demonstrated histologic improvement in 2 individuals followed serially. Improvement was not clearly related to vitamin D therapy. Abnormalities in mineral appositional rates and mineral maturation were identified in several additional patients. Studies in the long-term group did not indicate inexorable progression of metabolic bone disease. Although intestinal bypass produced several abnormalities in mineral metabolism during the first 2 yr after surgery, a trend toward normalization was evident after the period, possibly related to adaptive responses in the intestine.
D000042:Absorption; D000328:Adult; D000418:Albumins / Q000378:metabolism; D001706:Biopsy; D001851:Bone Diseases, Metabolic / Q000175:diagnosis* / Q000209:etiology; D002112:Calcifediol / Q000097:blood; D002118:Calcium / Q000378:metabolism; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008274:Magnesium / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010281:Parathyroid Hormone / Q000097:blood; D011446:Prospective Studies; D013997:Time Factors
D000418:Albumins; D010281:Parathyroid Hormone; D008274:Magnesium; D002112:Calcifediol; D002118:Calcium