Calcium/phosphate/vitamin D homeostasis and bone mass in patients after gastrectomy, vagotomy, and cholecystectomy

Abstract

Sixty-two outpatients were assessed and divided into the following groups: 20 patients who had had partial gastrectomy (PG group), 22 patients who had had truncal vagotomy and pyloroplasty (TV group) or high selective vagotomy (HSV group), and 20 patients who had had cholecystectomy (CH group). The patients' age ranged from 35 to 64 years (mean 45 years), and the average postoperative period was 9 years. None of the patients evidenced clinical or biochemical symptoms of malnutrition or malabsorption or of diseases affecting vitamin D metabolism. The function of the kidneys and the liver was normal. An age-matched group of volunteers served as a control group. The calcium dietary intake was determined using a standardized questionnaire; and the levels of serum calcium (Cas), phosphate (Ps), alkaline phosphatase (AP), and 25-hydroxyvitamin D [25(OH)D] and the excretion of Ca in a sample of fasting urine corrected for concurrent creatine excretion (FuCa/cr) were assessed by means of standard laboratory techniques. The bone mineral density (BMD) of the lumbar spine (L2-4) and femoral neck (neck-L) was determined by means of dual energy x-ray absorptiometry (DXA). The daily Ca dietary intake was lower than recommended (RDA) in 80% of the patients, with most of them ingesting less than 300 mg daily. The mean values of Cas, Ps, AP, and FuCa/cr did not differ from those in the controls. Significantly reduced 25(OH)D levels were observed in the PG group (7.0 ng/ml) (p < 0.001) and CH group (12.5 ng/ml) (p < 0.01) compared with the values in the control group (20.0 ng/ml).(ABSTRACT TRUNCATED AT 250 WORDS)

Vitamin D deficiency in elderly: Risk factors and drugs impact on vitamin D status

“…Given that bile salts are required for an efficient lipid and fat-soluble molecule absorption such as VD, cholecystectomy affects VD absorption. [ 64 ],[ 65 ] To the best our knowledge, to date, no data are available in the literature on the effect of cholecystectomy on 25(OH)D level in the elderly. Our analysis result did not show any association between cholecystectomy and 25(OH)D status.…”

Prevalence of vertebral alterations and the effects of calcium and vitamin D supplementation on calcium metabolism and bone mineral density after gastrectomy

“…Several factors might contribute to changes in calcium metabolism after gastrectomy including a decrease in calcium intake owing to milk intolerance, decreased release of calcium from food, impaired calcium absorption, fat malabsorption leading to the formation of calcium soaps and hypovitaminosis D, as well as rapid small intestinal transit6, 7, 13–15. A combination of these factors is probably responsible for the negative calcium balance6, 7 and a latent calcium deficiency after gastrectomy.…”

Calcium- und Knochenstoffwechsel nach Gastrektomie

“…Zur Therapie der nach Gastrektomie auftretenden Knochenverä nderungen wurde wiederholt die Substitution mit Vitamin D und Calcium empfohlen [13,38,63]. Es liegt aber bisher lediglich eine prospektive klinische Studie vor, die ü ber den Einsatz von Vitamin D und Calcium berichtet [3].…”

“…Das klinische Bild und die Ä tiologie der Knochenverä nderungen nach Gastrektomie konnten nicht mit bekannten Knochenerkrankungen in Einklang gebracht werden, weshalb der Begriff "postgastrectomy bone disease" geprä gt wurde [15], der heute im englischsprachigen Raum als eigene Entitä t anerkannt ist [63]. Dabei wurde eine Abnahme der corticalen und trabeculä ren Knochenmasse sowohl im Bereich peripherer Knochen als auch im Bereich des Achsenskeletts festgestellt [14,23,31,38,40,45,59], welche mit einer Zunahme des Frakturrisikos einhergeht [14,40].…”