Prevalence of vertebral alterations and the effects of calcium and vitamin D supplementation on calcium metabolism and bone mineral density after gastrectomy.
BACKGROUND
Bone disease is common after gastrectomy, resulting in decreased bone mass and an increased risk of fracture. No proven therapy is currently available.


METHODS
Serum markers of calcium metabolism in 98 patients after partial or total gastrectomy were compared with those in 30 age- and sex-matched healthy controls. Patients with disorders of calcium metabolism were investigated by conventional radiography and single-energy computed tomography of the spine. Forty patients participated in a 1-year follow-up study to investigate the effects of vitamin D and calcium supplementation on calcium metabolism and bone mineral density.


RESULTS
Altered serum markers of calcium and phosphate metabolism were observed in 77 (79 per cent) of 98 patients. Sixty (79 per cent) of these had vertebral alterations. Vertebral fractures were detected in 22 patients, grade I vertebral deformities in 50 patients, grade II deformities in 22 patients and osteopenia (Z-score less than - 1) in 30 patients. Calcium and vitamin D supplementation resulted in an increase in 25-hydroxy-vitamin D (P < 0.001), 1,25-dihydroxy-vitamin D (P = 0.048) and osteocalcin (P = 0.045), whereas levels of parathyroid hormone were decreased (P = 0.007). Bone mineral density did not change over time.


CONCLUSIONS
Disturbances of calcium and bone metabolism are common after gastrectomy. Calcium and vitamin D supplementation normalized levels of markers of calcium metabolism and might have prevented age-related bone mass loss, although it did not increase bone mineral density after 1 year.
Glatzle
J
J
Department of General, Visceral and Transplantation Surgery, University Hospital, Tübingen, Germany.
Piert
M
M
Meile
T
T
Besenthal
I
I
Schäfer
J F
JF
Königsrainer
A
A
Zittel
T T
TT
D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001847:Bone Diseases / Q000209:etiology / Q000517:prevention & control*; D002118:Calcium / Q000008:administration & dosage* / Q000378:metabolism; D016022:Case-Control Studies; D019587:Dietary Supplements; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries; D008297:Male; D008875:Middle Aged; D016103:Spinal Fractures / Q000209:etiology / Q000517:prevention & control; D014807:Vitamin D / Q000008:administration & dosage*
D015415:Biomarkers; D014807:Vitamin D; D002118:Calcium