Osteopenia and osteomalacia after gastrectomy: interrelations between biochemical markers of bone remodelling, vitamin D metabolites, and bone histomorphometry.

The prevalence of metabolic disease in a population of 68 postgastrectomy patients was assessed using histomorphometric evaluation of transiliac bone biopsy specimens after tetracycline double labelling. Trabecular bone volume was significantly lower in the postgastrectomy group (p less than 0.01): 62% of the patients had increased osteoid surface, 56% increased osteoid thickness, and 24% increased mineralisation lag time. Only 18%, however, fulfilled the diagnostic criteria for osteomalacia--increased osteoid thickness and increased mineralisation lag time. Postgastrectomy patients had reduced serum concentrations of calcium (p less than 0.01), phosphate (p less than 0.01), and 25-hydroxyvitamin D, while levels of alkaline phosphatase and 1,25 dihydroxyvitamin D were high (p less than 0.01). The severity of the mineralisation defect as reflected by mineralisation lag time was positively correlated to serum 25-hydroxyvitamin D, but unrelated to serum 1,25-dihydroxyvitamin D. Multiple linear regression analysis showed that serum 25-hydroxyvitamin D, age, and the duration of postoperative follow up were significant determinants of the mineralisation defect in a given patient. The limited value of serum markers in the diagnosis of osteomalacia was emphasised by the fact that six of the eight patients with osteomalacia had normal serum levels of calcium and alkaline phosphatase, and five of the eight had values for 25-hydroxyvitamin D in the normal range for healthy control subjects. The results clearly show the need for vitamin D supplementation and regular control after gastric resection.

[1]  F. Melsen,et al.  Histomorphometric analysis of bone in metabolic bone disease. , 1989, Endocrinology and metabolism clinics of North America.

[2]  M. Drezner,et al.  Bone histomorphometry: Standardization of nomenclature, symbols, and units: Report of the asbmr histomorphometry nomenclature committee , 1987, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.

[3]  E. Eriksen,et al.  Normal and pathological remodeling of human trabecular bone: three dimensional reconstruction of the remodeling sequence in normals and in metabolic bone disease. , 1986, Endocrine reviews.

[4]  S. Buus,et al.  Food intake and nutritional status after gastrectomy. , 1986, Human nutrition. Clinical nutrition.

[5]  C. Christiansen,et al.  Regulation of vitamin D and calcium metabolism after gastrectomy. , 1985, Gut.

[6]  L. Mosekilde,et al.  Osteopenia with normal vitamin D metabolites after small-bowel resection for Crohn's disease. , 1984, Scandinavian journal of gastroenterology.

[7]  K. Syrjänen,et al.  Long-term follow-up after Billroth I and II partial gastrectomy. Gastrointestinal tract function and changes in bone metabolism. , 1984, Acta chirurgica Scandinavica.

[8]  Robert R. Sokal,et al.  The Principles and Practice of Statistics in Biological Research. , 1982 .

[9]  L. Mosekilde,et al.  Serum levels of vitamin D metabolites and bone remodelling in hyperthyroidism. , 1982, Metabolism: clinical and experimental.

[10]  L. Mosekilde,et al.  Low serum levels of 1.25-dihydroxyvitamin D and histomorphometric evidence of osteomalacia after jejunoileal bypass for obesity. , 1980, Gut.

[11]  F. Melsen,et al.  Dynamic differences in trabecular bone remodeling between patients after Jejuno-ileal bypass for obesity and epileptic patients receiving anticonvulsant therapy , 1980 .

[12]  O. H. Sørensen,et al.  Measurement of circulating 1,25-dihydroxyvitamin D in man. Changes in serum concentrations during treatment with 1 alpha-hydroxycholecalciferol. , 1979, Acta endocrinologica.

[13]  O. H. Sørensen,et al.  Measurement of 25-hydroxyvitamin D in serum and its relation to sunshine, age and vitamin D intake in the Danish population. , 1979, Scandinavian journal of clinical and laboratory investigation.

[14]  M. Christensen,et al.  Bone composition and vitamin D after Pólya gastrectomy. , 2009, Acta medica Scandinavica.

[15]  H. DeLuca,et al.  Response of intestinal calcium transport and bone calcium mobilization to 1,25-dihydroxyvitamin D3 in thyroparathyroidectomized rats. , 1974, Endocrinology.

[16]  H. DeLuca,et al.  The control of 25-hydroxyvitamin D metabolism by inorganic phosphorus. , 1973, Archives of biochemistry and biophysics.

[17]  D. Morgan,et al.  THE OSTEOMALACIA SYNDROME AFTER STOMACH OPERATIONS1 , 1970 .

[18]  D. Morgan,et al.  The osteomalacia syndrome after stomach operations. , 1970, The Quarterly journal of medicine.

[19]  R. Pridie,et al.  Postgastrectomy osteomalacia: Incidence after the no‐loop and other types of gastrectomy , 1966, The British journal of surgery.

[20]  D. Morgan,et al.  Search for osteomalacia in 1228 patients after gastrectomy and other operations on the stomach. , 1965, Lancet.

[21]  D. J. Deller,et al.  Metabolic effects of partial gastrectomy with special reference to calcium and folic acid , 1964, Gut.

[22]  J. A. Williams Effects of upper gastro‐intestinal surgery on blood formation and bone metabolism , 1964, The British journal of surgery.

[23]  B. Harvald,et al.  Calcium deficiency following partial gastrectomy. , 2009, Acta medica Scandinavica.