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KMID : 0438420060130020157
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Korean Journal of Bone Metabolism
2006 Volume.13 No. 2 p.157 ~ p.165
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Association between The Bone and Mineral Metabolism and Postgastrectomy in Stomach Cancer Patients - A One Year Prospective Study -
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Le Seong-Su
Baek Ki-Hyun
Tae Hyun-Jung
Lim Dong-Jun
Kim Mee-Kyoung
Han Je-Ho
Park Woo-Chan
Jeon Hae-Myung
Cha Bong-Youn
Son Ho-Young
Lee Kwang-Woo
Kang Sung-Koo
Kang Moo-Il
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Abstract
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Background: Although bone disease is commonly associated with gastric surgery, the effect of gastrectomy on bone metabolism and bone mineral density are still unclear. The purpose of this study was to clarify the decrement of bone mineral density (BMD) after gastrectomy using dual-energy X-ray absorptionmetry (DEXA) and the pathogenesis of postgastrectomy bone disease by measurement of other bone-related serum marker.
Methods: This study was designed for prospective, 1 year follow- up after gastrectomy. The forty-six patient had been enrolled. The thirty-six patients were analyzed in the end. There were 24 men, 6 premenopausal women and 6 postmenopausal women, aged 48~68 years, mean 58 years. The bone mineral density of L2-L4 spine and femur were measured using dual-energy X-ray absorptiometry. In all patients, the blood was sampled to check the serum calcium, phosphorus, bone turn over marker. The serum iPTH and 25(OH) vit D levels were determined before and one year after gastrectomy.
Results: The mean bone loss in lumbar spine, total proximal femur, femoral neck, and the trochanter, which was calculated as the percentage change from the baseline to the level at one year, was 5.9% (p<0.05), 5.3% (p<0.01), 6.4% (p<0.01) and 8.7% (p<0.01) respectively. The bone loss was generally higher in a group who received chemotherapy (p<0.05). The serum calcium and phosphorus levels were not changed significantly and within the normal range throughout the observation period. After gastrectomy, the level of 1 CTP increased and reached a peak at 1 month (9.6±2.9 ng/mL; p<0.01 vs. baseline). Thereafter, it progressively declined; however the 1 CTP levels were still higher compared to the baseline at 1 year after gastrectomy (6.6±3.0 ng/mL; p<0.05 vs. baseline). During the observation period, there were no significant changes in the levels of osteocalcin. The level of 25(OH) vit D at 1 year postgastrectomy was not significantly changed compared to the baseline. However, iPTH levels higher at 1 year than before gastrectomy (33.9±10.2 pg/mL, 49.4±20.5 pg/mL; p<0.01; mean percentage change, 61.6%). Albeit not significant, iPTH levels at 1 year postgastrectomy tended to be negatively associated with the percentage changes in the BMD of the lumbar spine from the baseline to 1 year.
Conclusion: The data in this study provide evidence that profound bone loss occurs and increased bone resorption supervenes during the early postgastrectomy period. In addition, it is conceivable that gastrectomy related bone loss may be due, at least in part, to the overproduction of PTH.
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KEYWORD
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Bone mineral density, Osteoporosis, Gastrectomy
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