Bone mineral density after treatment for gastric cancer

Abstract

Changes in bone metabolism among gastric cancer survivors have long been recognized. The aim of our study was to clarify the changes of bone mineral density (BMD) among gastric cancer survivors who underwent endoscopic resection or gastrectomy. Forty-nine patients diagnosed with tumor, node, and metastasis (TNM) stage 1 gastric cancer with pathologic confirmation, who underwent BMD measurement just before the procedure, and had no prior osteoporosis treatment, were studied. BMD was measured with dual energy x-ray absorptiometry before and after treatment. Laboratory tests were performed using fresh serum, and serum levels of alkaline phosphatase, albumin, calcium, and phosphorus were measured. We used a nested case-control design to compare groups. Of the 49 patients, 34 underwent gastrectomy and 15 underwent endoscopic treatment. There were no differences in baseline clinical characteristics, including BMD, and biochemical data between groups. The mean and median follow-up intervals for BMD measurement were 32.6 months (standard deviation, 16.5) and 31.0 months (interquartile range: 21.5, 41.0), respectively. The follow-up BMDs of the femoral neck and total hip were lower in the gastrectomy group (P = .010 and .011, respectively). The percentage changes in BMD for the lumbar spine, femoral neck, and total hip were −3.30%, −1.52%, and 0.40%, respectively, in the endoscopic treatment group, and −7.17%, −6.30%, and −3.49%, respectively, in the gastrectomy group. Bone loss of the lumbar spine and femoral neck were greater in the gastrectomy group (P = .028 and .022, respectively). BMD is lower after gastrectomy than after endoscopic treatment among early stage gastric cancer survivors.

Helicobacter pylori Related Diseases and Osteoporotic Fractures (Narrative Review)

“…According to most but not all studies [ 192 , 193 ], gastric cancer survivors who underwent gastrectomy, compared to the general population [ 194 , 195 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 ] or age- and sex-matched healthy controls [ 205 , 206 , 207 , 208 ], have significantly lower BMD, higher prevalence of osteopenia/OP (38.3% [ 196 ] to 55% [ 203 ]) and higher fracture rates (approximately 40% [ 196 , 200 , 205 ]). Bone loss (although of a lesser degree) was also reported in gastric cancer survivors after endoscopic tumor resection undertaken in early stage [ 202 ]. In South Korea, nationwide cohort study of cancer survivors who underwent gastrectomy ( n = 133,179 matched to non-cancer controls, 1:1) demonstrated an increased risk of fractures (HR 1.61; 95% CI 1.53–1.70), which was higher in patients after total gastrectomy (HR 2.18; 95% CI 1.96–2.44) and adjuvant chemotherapy (HR 2.01; 95% CI 1.81–2.23); the elevated OF risk was significantly associated with anemia [ 208 ].…”

“…The causes of OP and subsequent fractures in patients with gastric cancer are multifactorial. Malabsorption (especially of calcium, phosphate, iron, proteins, vitamins B12 and D), malnutrition, weight loss, use of certain medications (e.g., fluorouracil and cisplatin which induce apoptosis of osteoblasts and increase osteoclast activity [ 215 , 216 , 217 ], hormones, radiotherapy, comorbidities, physical inactivity, old age and smoking–all were documented as factors contributing to bone loss and OFs in gastric cancer patients [ 198 , 200 , 202 , 203 , 214 , 217 , 218 ].…”

The correlation between serum levels of alkaline phosphatase and bone mineral density in adults aged 20 to 59 years

“…[11,12] Recently, its serum levels were correlated with bone metabolism and BMD. [13][14][15][16][17] Our study investigated this correlation in adults aged 20 to 59 years and found a negative correlation between serum ALP levels and pelvic BMD, which persisted after adjusting for confounders (Table 2). Females exhibited a more significant negative correlation between serum ALP levels and pelvic BMD than that exhibited by males.…”

Bone Fragility in Gastrointestinal Disorders

“…With the increasing number of long-term survivors after gastrectomy, there has been increasing interest in the clinical management of post-gastrectomy syndromes and their possible complications. Among these complications, several reports indicated that patients with gastric cancer, and particularly gastric cancer survivors who underwent gastrectomy, have an increased risk of osteoporosis and fragility fractures [ 153 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 ]. This is in keeping with previous observations in patients with gastrectomy for peptic ulcer disease [ 169 ].…”

“…Despite some studies suggesting an increased risk of osteoporosis after total gastrectomy than partial gastrectomy [ 170 ], or Roux-en-Y than Billroth-I reconstruction [ 171 ], it remains unclear which surgical procedure for gastric cancer confers a greater risk to bone health. Indeed, a certain degree of bone loss has also been described in a restricted cohort of gastric cancer survivors with early stage gastric cancer after endoscopic tumor resection [ 162 ]. In addition to osteoporosis and fractures, calcium malabsorption, together with an increased risk of osteomalacia, has also been described after gastrectomy [ 157 , 172 ].…”