Changes in bone metabolism and body composition after total gastrectomy: results of a longitudinal study

Decreased bone mineral density and an increased risk of fracture have been reported many years after gastric resections due to peptic ulcer disease. Corresponding information after total gastrectomy is, however, contradictory and incomplete. Twenty-two gastric cancer patients who were long-term survivors after total gastrectomy (mean of eight years) were investigated. They had whole body DXA scans performed both after a mean of five and eight years after the operation. Serum levels of relevant blood tests were determined. Our patients lost 3.2 kg of their body weight (P<0.006) with a corresponding loss of lean body mass (P<0.0001). We were unable to demonstrate any difference in bone density from values seen in age- and sex-matched controls. We found a slight elevation of osteocalcine levels but only a minor increase in parathyroid hormone levels. Body weight had the greatest impact on the T score. The impact of total gastrectomy on calcium homoeostasis and bone mineral density seems to be marginal. The close relationship between bone mineral density and body weight suggest the pivotal importance of maintaining weight control.