Short-term changes in bone and mineral metabolism following gastrectomy in gastric cancer patients
Introduction
The gastrointestinal tract is of vital importance to other organs in the body, including the skeleton, by functioning as a gateway for nutrients, proteins, vitamins and minerals. Diseases and conditions that affect the stomach are characterized by malabsorption and while the exact pathogenetic mechanisms are not known, malabsorption of calcium and vitamin D with consequent increased production of parathyroid hormone (PTH) may play important roles in bone loss [1], [2]. In fact, low bone mineral density has been reported on several occasions for patients who have undergone gastrectomy for peptic ulcer or cancer [3], [4], [5], [6], [7], [8]. In addition, postgastrectomy states are associated with increased risks of bone fracture [9], [10], [11], [12], [13].
The incidence of peptic ulcer disease has been decreasing concomitantly with improved medical therapy for this condition [14]. This result has led to a marked reduction in peptic ulcer surgery [15]. However, gastrectomy remains a treatment of choice for operable gastric cancer and large numbers of patients undergo partial or total gastrectomy at present. In general, the world-wide incidence and mortality rates for gastric cancer have decreased markedly during the past years. Nonetheless, about 20,000 new cases of gastric cancer were diagnosed in the United States in 2004 [16] and the incidence of the disease remains high in Japan, China, Chile, Ireland, and Korea [17], [18].
Most previous reports of post-gastrectomy bone disease have been case-control studies. Most patients were operated upon in the past for which long-term outcome data were compared with age- and sex-matched control subjects. No prospective studies have been reported that quantify the amount of bone loss after gastrectomy within the same patients. The purpose of the present prospective study was to describe the short-term changes in bone turnover markers and bone mineral density (BMD) after gastrectomy for gastric cancer. During the 1-year follow-up, BMD was measured before and 1 year after gastrectomy. Markers of bone formation and bone resorption were measured at intervals during the year-long follow-up, to enable greater understanding of the mechanism responsible for bone loss in the post-gastrectomy period. This study also determined changes in the levels of 25-hydroxyvitamin D and PTH and allowed speculation as to their influence on bone metabolism.
Section snippets
Patients and sample collection
A total of 46 patients who had received gastrectomy for gastric adenocarcinoma were enrolled in this study. Those patients in whom the operative procedure was incomplete (n = 2), who died (n = 4), relapsed (n = 2), and were lost during follow-up (n = 2) were excluded from this group. Therefore, 36 patients whose BMD could be measured before and at 1 year after gastrectomy were available for analysis (Table 1). This study was approved by the Institutional Review Board of St. Mary's Hospital (Seoul,
Clinical characteristics
Baseline clinical characteristics were summarized in Table 1. On average, these patients lost 5.7 ± 4.4 kg in weight (63.8 ± 9.5 kg to 57.5 ± 9.1 kg) with a BMI decrease of 8.6 ± 5.5% over 12 months (both P < 0.01). No patient was found to have evidence of local recurrence or distant metastasis at the time of follow-up.
Changes in bone turnover markers after gastrectomy
The ICTP levels increased immediately after gastrectomy and reached peak at levels at 1 and 3 months (9.9 ± 3.0 ng/ml and 9.7 ± 4.6 ng/ml; 106 ± 123% and 103 ± 136%; P < 0.01 vs. baseline).
Discussion
“Primary” osteoporosis refers to osteoporosis that results from involutional bone loss associated with aging and, in women, those additional bone losses related to natural menopause. Osteoporosis that is caused or exacerbated by other disorders or as a result of medications is referred to as “secondary” osteoporosis. There are many causes of secondary osteoporosis including hypogonadism, endocrine disorders, gastrointestinal diseases, transplantation, and genetic disorders.
In this longitudinal
Acknowledgments
A section of these results was presented in abstract form at the 28th Annual Meeting of the ASBMR, Philadelphia, PA, 2006. This study was supported by a grant from the Korea Health 21 R&D project, Ministry of Health and Welfare, Republic of Korea (0405-DB01-0104-0006).
References (40)
- et al.
Bone mineral metabolism after total gastrectomy
Bone
(2001) - et al.
Metabolic bone disease following gastrectomy: assessment by dual energy X-ray absorptiometry
Br J Surg
(1992) - et al.
High prevalence of bone disorders after gastrectomy
Am J Surg
(1997) - et al.
Risk factors for spinal osteoporosis in men: Role of tobacco use and alcohol consumption
Am J Med
(1983) - et al.
Partial gastrectomy and mineral metabolism: effects on gastrin–calcitonin release
Bone Miner
(1990) - et al.
Bisphosphonate incadronate prevents total gastrectomy-induced osteopenia in rats
Bone
(2004) - et al.
Bone, body weight, and weight reduction: what are the concerns?
J Nutr
(2006) - et al.
Osteopenia and osteomalacia after gastrectomy: interrelations between biochemical markers of bone remodelling, vitamin D metabolites, and bone histomorphometry
Gut
(1991) - et al.
A review of postgastrectomy bone disease
J Gastroenterol Hepatol
(1992) - et al.
Osteoporosis after gastrectomy: bone mineral density of lumbar spine assessed by dual-energy X-ray absorptiometry
Calcif Tissue Int
(2000)
Osteoporosis after total gastrectomy: results of a prospective, clinical study
Scand J Gastroenterol
Calcium/phosphate/vitamin D homeostasis and bone mass in patients after gastrectomy, vagotomy, and cholecystectomy
World J Surg
Chronological changes in bone mineral content following gastrectomy
Surg Today
Risk factors for hip fracture in men from southern Europe: the MEDOS study
Osteopor Int
Osteoporosis, metabolic aberrations, and increased risk for vertebral fractures after partial gastrectomy
Calcif Tissue Int
Determinants of osteoporotic thoracic vertebral fracture. Screening of 57,000 Finnish women and men
Acta Orthop Scand
Peptic ulcer
Time trends in peptic ulcer surgery, 1956 to 1986: a nation-wide survey in Sweden
Ann Surg
Gastrointestinal tract cancer
Gastric carcinoma
N Engl J Med
Cited by (38)
Gastric cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
2022, Annals of OncologyEffect of bisphosphonate on the prevention of bone loss in patients with gastric cancer after gastrectomy: A randomized controlled trial
2020, BoneCitation Excerpt :Based on the mechanism of inhibiting bone resorption, bisphosphonates may impact bone and mineral metabolism in gastric cancer patients with gastrectomy. Previously, our observations suggested that anti-resorptive treatment could be effective, since bone resorption is prevalent immediately after gastrectomy [7]. Therefore, we aimed to evaluate the effects of bisphosphonate on bone and mineral metabolism after gastrectomy.
Increased risk of osteoporotic fracture in community-dwelling elderly men 20 or more years after gastrectomy: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study
2019, BoneCitation Excerpt :While these studies clearly demonstrate a significantly increased fracture risk after gastrectomy, they did not assess bone metabolic status or areal bone mineral density (aBMD) of their study populations. On the other hand, several clinic-based follow-up studies have reported increased levels of PTH [13] and bone turnover markers [14], decreased aBMD [13,14,19], and increased incidence rate of fractures [15] during relatively short follow-up periods ranging from one to six years, again without a non-gastrectomized control group for comparison. Thus, the effects of gastrectomy on bone metabolism, aBMD, and fracture risk remain unclear, especially in the long-term.
Proton Pump Inhibitor Use and Risk of Hip Fracture in Kidney Transplant Recipients
2017, American Journal of Kidney DiseasesFracture after gastrectomy for gastric cancer: A long-term follow-up observational study
2017, European Journal of CancerGastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up
2016, Annals of OncologyCitation Excerpt :Follow-up should be tailored to the individual patient and the stage of the disease [V, B] [100]. Dietary support is recommended for patients on either a radical or a palliative pathway with reference to vitamin and mineral deficiencies [V, B] [101, 102]. New strategies for patient follow-up are currently undergoing evaluation, including patient-led self-referral and services led by clinical nurse specialists [103].