Hypocalcemia and osteomalacia after bariatric surgery

Abstract

SummaryIntroduction. Obesity has become a major health problem not only in industrialized societies but also in developing countries. Multiple studies have shown that bariatric surgery has been effective in reducing substantial amount of weight and also the comorbidities and is being performed more frequently as an established treatment. Due to anatomical and physiological alterations after surgery that impairs absorption of vitamin D and calcium, two fundamental factors in bone formation, their intestinal absorption is highly compromised. Case report. We present a 48-year-old woman who was visited in emergency room for generalized bone pain, perioral paresthesia and carpopedal spasm. She had undergone bariatric surgery 15 years ago. Chvostek's sign and Trousseau's sign were positive. Examination of thoracic ribs elicited severe pain on palpation. Laboratory evaluation revealed: Ca = 6.1 mg/dL, P= 2.1 mg/dL, alkaline phosphatase = 432 (160-303), PTH=541 pg/mL, and 25(OH)D3= 3 ng/mL. Whole body bone scan showed increased uptake in the anterior arc of left 6 th rib, posterior arc of left 6 th and 12 th ribs with increased uptake of costochondral joints. Conclusion. Our case highlights the possible consequences that bariatric surgery may have on bone and mineral health and the need for regular and proactive follow-up of the patients.

Metabolic and Gut Microbial Characterization of Obesity-Prone Mice under a High-Fat Diet

“…Obesity is the critical risk factor for metabolic diseases including type 2 diabetes, cardiovascular disease, metabolic syndrome (encompassing hypertension, dyslipidemia, and insulin resistance), and non-alcoholic fatty liver disease. , The etiology of obesity involves complicated interactions between genetic and environmental factors such as dietary nutrients and physical activity . In addition, numerous investigations have indicated that gut dysbiosis is intricately involved in the development of obesity , and obesity-related metabolic diseases. , …”

Effect of Body Mass Index on Femur Fracture Location: A Retrospective Database Study

“…The extensive anatomic changes to the gastrointestinal tract caused by bariatric surgery are known to cause various macronutrient deficiencies, including protein-calorie malnutrition and fat malabsorption, which can, in turn, lead to hypocalcemia and osteomalacia. 22,23…”

“…The extensive anatomic changes to the gastrointestinal tract caused by bariatric surgery are known to cause various macronutrient deficiencies, including protein-calorie malnutrition and fat malabsorption, which can, in turn, lead to hypocalcemia and osteomalacia. 22,23 There is no current consensus on the effects of bariatric surgery fracture risk. A 2012 retrospective cohort study in the United Kingdom (n = 10,442) and a 2020 retrospective cohort study in the United States (n = 49,113) found that bariatric surgery had no effect on the risk of fracture.…”

Characteristics of calcium and phosphorous metabolism in patients after bariatric surgery and the role of vitamin d supplementation in the prevention and treatment of postoperative bone and mineral disorders

“…Значимость контроля за состоянием костного метаболизма после бариатрической хирургии подтверждается множеством описанных случаев низкотравматичных переломов костей позвоночника и проксимального отдела бедра через несколько лет после проведения данных операций [35,36,37].…”