OSTEOPOROSIS, METABOLIC ABERRATIONS, AND INCREASED RISK FOR VERTEBRALFRACTURES AFTER PARTIAL GASTRECTOMY

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 fractu res in 19% compared with 4% (P < 0.01) in the control population. Bone mineral density (BMD) in the right calcaneus measured with dual energ y photon absorptiometry was 20% lower in men with a Billroth 11 operat ion (P < 0.001) and 8% lower with a Billroth I operation (ns). In comp arison with the controls, the men subjected to partial gastrectomy had higher serum concentrations of osteocalcin and alkaline phosphatase a ctivity, a lower serum concentration of 25-hydroxyvitamin D (25OHD) an d a lower body mass index (BMI). There were no differences in serum co ncentrations of free calcium, intact parathyroid hormone (PTH), or fre e thyroxine. The smoking prevalence was significantly higher in men wi th partial gastrectomy than in controls. Smokers had significantly low er serum concentrations of intact PTH and 25OHD than nonsmokers and al so lower BMD and BMI. The relationships between intact PTH on one hand , and ionized calcium (inverse relationship) and osteocalcin (direct r elationship) on the other were preserved in smokers, however. Gastrosc opy was performed in 78 men with multiple biopsies in the gastric remn ant and also in the small intestine. All but two subjects had chronic gastritis. Examination of sternal bone marrow smears showed that 40% o f the Billroth-operated men lacked bone marrow reticular iron. In seve ral cases with low BMD and vertebral fractures iliac bone biopsies wer e performed, but no evidence of osteomalacia was found.