Low bone mineral density after total gastrectomy in males: A preliminary report emphasizing the possible significance of urinary net acid excretion, serum gastrin and phosphorus

The bone mineral density (BMD) and the associated extracellular status of m ineral and acid-base metabolism were evaluated in 11 males, 3 - 18 years af ter total gastrectomy (GX). In the lumbar spine, but not in the femoral nec k, BMD was decreased in seven, normal in th ree, and falsely high in one in dividual. Relative to the limits of normalcy, fasting serum levels of gastr in were low, but normal for calcium, phosphorus, parathyroid hormone, calci tonin and vitamin D, while the level of total alkaline phosphatase was elev ated; fasting urine pH and calcium were low, while phosphorus and net acid were high. Regression analyses revealed serum gastrin and phosphorus, and u rinary net acid as possible predictors of BMD. It was concluded that over t he long-term GX evokes low BMD, but not hyperparathyroidism and deranged vi tamin D metabolites. Future studies may focus on gastrin, parathyroid hormo ne-independent hyperphosphaturia and disturbed acid-base metabolism as indi cators of a new extra-cellular equilibrium of minerals.