BONE DISORDERS FOLLOWING TOTAL GASTRECTOMY

Bone disorders following gastrectomy were studied by measuring absolut e and relative bone mineral density of the Wards triangle, serum 1,25- (OH)(2)-D, alkaline phosphatase, and total serum calcium. The subjects were 20 males who had undergone total gastrectomy not more than three months previously (group A(1)). Seventeen of these patients were revi ewed three years later (group A(2)). Absolute and relative bone densit y were significantly lower in group A(2) than in A(1) (0.52 +/- 0.011 g/cm(2) versus 0.6 +/- 0.014 g/cm(2), P < 0.01 and 85.5 +/- 1.4% age-m atched control versus 95 +/- 1.3%, P < 0.01). 1,25-(OH)(2)-D was signi ficantly lower in group A(2) than in group A(1) (14.3 +/- 0.97 pg/ml v ersus 20.6 +/- 1.02 pg/ml, P < 0.01). There was no difference in alkal ine phosphatase and calcium serum concentration. The mean weight loss was 6.26 +/- 0.57% over the follow-up period, and weight loss correlat ed with absolute and relative bone density (r = -0.74, P < 0.01). Ther e was a positive correlation between 1,25-(OH)(2)-D and absolute or re lative bone density (r = 0.67, r = 0.62 and P < 0.01). These data sugg est that bone density decrease has already occurred three years after total gastrectomy and is positively correlated to 1,25-(OH)(2)-D defic iency. As no differences in serum alkaline phosphatase and serum calci um concentration were found, these factors are of little value for the early detection of postgastrectomy bone disorders, whereas weight los s is a valuable screening parameter.