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CALCIUM METABOLISM AND THE BONES AFTER PARTIAL GASTRECTOMY
Author(s) -
DELLER D. J.,
EDWARDS R. G.,
ADDISON M.
Publication year - 1963
Publication title -
australasian annals of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0571-9283
DOI - 10.1111/imj.1963.12.4.295
Subject(s) - osteomalacia , gastrectomy , medicine , calcium , endocrinology , gastroenterology , bone remodeling , excretion , calcium metabolism , alkaline phosphatase , rickets , osteoporosis , vitamin d and neurology , chemistry , biochemistry , enzyme , cancer
SUMMARY Some aspects of calcium metabolism were investigated in 100 patients after partial gastrectomy in an endeavour to define the nature of the skeletal abnormality and to detect factors responsible for its development. Fifty subjects not operated upon were used as the control group. The following abnormal biochemical values were found in the patients after partial gastrectomy : low serum calcium levels in six patients ; low serum phosphate levels in six patients ; raised serum alkaline phosphatase levels in 15 patients ; low serum total protein level in one patient ; and low serum albumin level in one patient. In addition, the excretion of calcium in the urine was lower in the patients after gastrectomy than in the control subjects, and the “clearance” of phosphate was higher in the patients after gastrectomy. Patients with changes in the bones after gastrectomy differed from the patients with normal bones after operation in having a higher mean serum level of alkaline phosphatase and a lower mean urinary excretion of calcium. Twenty‐two patients after partial gastrectomy were further investigated by bone biopsy, the calcium infusion test and fæcal fat determination. Eight control subjects also underwent the calcium infusion test. On the basis of these investigations, 13 patients were considered to have an “osteomalacic” syndrome. The main features of the syndrome were generalized skeletal pain, bone tenderness, skeletal rarefaction and histological changes of osteoporosis and early osteomalacia. We have used the term “osteomalacic” syndrome to describe this condition, because the classical biochemical features of osteomalacia were only infrequently present, and because osteomalacia and osteoporosis were present together. The biochemical changes that were present in the 13 patients with the syndrome were elevation of the serum alkaline phosphatase levels in five patients, increased retention of infused calcium in the calcium infusion test in seven patients, hypocalcæmia in one patient and hypophosphatæmia in another patient. Anæmia, steatorrhœa and an inadequate diet were frequently present in these cases. Factors that appeared to be of importance in the pathogenesis of the bone disorder following gastrectomy were inadequate intake of calcium and protein in the diet, and steatorrhœa. A deficiency of vitamin D also was inferred to account for the changes that were detected. The observations made in the present investigation suggest that bone disease is relatively common after gastric surgery, but that in most cases the disorder is only of moderate severity and does not constitute a serious disability to the patient. However, an awareness of the association of bone disease and gastric surgery is important, as some patients after gastrectomy may require treatment with calcium, vitamin D and an anabolic steroid.