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Osteoporosis, Metabolic Aberrations, and Increased Risk for Vertebral Fractures After Partial Gastrectomy

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Abstract

A case-control study compared 129 men with earlier partial gastrectomy (operation during the period 1952–1961) with 216 men from a community-based population study. All were born 1910–1915 and the mean age was 72 years. Men with a previous partial gastrectomy had vertebral fractures in 19% compared with 4% (P < 0.01) in the control population. Bone mineral density (BMD) in the right calcaneus measured with dual energy photon absorptiometry was 20% lower in men with a Billroth II operation (P < 0.001) and 8% lower with a Billroth I operation (ns). In comparison with the controls, the men subjected to partial gastrectomy had higher serum concentrations of osteocalcin and alkaline phosphatase activity, a lower serum concentration of 25-hydroxyvitamin D (250HD) and a lower body mass index (BMI). There were no differences in serum concentrations of free calcium, intact parathyroid hormone (PTH), or free thyroxine. The smoking prevalence was significantly higher in men with partial gastrectomy than in controls. Smokers had significantly lower serum concentrations of intact PTH and 250HD than nonsmokers and also lower BMD and BMI. The relationships between intact PTH on one hand, and ionized calcium (inverse relationship) and osteocalcin (direct relationship) on the other were preserved in smokers, however. Gastroscopy was performed in 78 men with multiple biopsies in the gastric remnant and also in the small intestine. All but two subjects had chronic gastritis. Examination of sternal bone marrow smears showed that 40% of the Billroth-operated men lacked bone marrow reticular iron. In several cases with low BMD and vertebral fractures iliac bone biopsies were performed, but no evidence of osteomalacia was found.

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Acknowledgments

This population study was made possible by grants from the Swedish Council for Planning and Coordination of Research and the Swedish Medical Research Council.

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Authors and Affiliations

  1. Department of Geriatric Medicine, University of Gothenburg, Sweden

    Dan Mellström, Christer Johansson & Bengt-Olof Ytterberg

  2. Department of Orthopaedics, University of Lund, Sweden

    Olof Johnell & Karl Obrant

  3. Department of Clinical Chemistry, University of Gothenburg, Sweden

    Göran Lindstedt & P.-A. Lundberg

  4. Department of Surgery, University of Gothenburg, Sweden

    Ivi-Mai Schöön

  5. Department of Medicine, University of Linköping, Sweden

    Göran Toss

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  1. Dan Mellström
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  2. Christer Johansson
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  3. Olof Johnell
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  4. Göran Lindstedt
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  5. P.-A. Lundberg
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  6. Karl Obrant
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  9. Bengt-Olof Ytterberg
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Mellström, D., Johansson, C., Johnell, O. et al. Osteoporosis, Metabolic Aberrations, and Increased Risk for Vertebral Fractures After Partial Gastrectomy. Calcif Tissue Int 53, 370–377 (1993). https://doi.org/10.1007/BF03549778

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  • DOI: https://doi.org/10.1007/BF03549778

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