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Osteomalacia after Roux-en-Y gastric bypass
Maria L Collazo-Clavell1, Antonio Jimenez, Stephen F Hodgson
1Division of Endocrinology, Metabolism and Nutrition, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
Summary
Roux-en-Y gastric bypass can lead to metabolic bone disease, including osteomalacia. Early diagnosis and treatment with calcium and vitamin D are crucial for recovery and improved bone density.
Area of Science:
- Endocrinology
- Metabolic Bone Disease
- Bariatric Surgery Outcomes
Background:
- Morbid obesity is often treated with Roux-en-Y gastric bypass (RYGB).
- RYGB can lead to long-term metabolic complications, including bone disease.
- Late diagnosis of metabolic bone disease can complicate treatment.
Observation:
- A 42-year-old woman with a history of RYGB presented with osteoporosis unresponsive to bisphosphonates.
- She exhibited vitamin D deficiency, secondary hyperparathyroidism, and biochemical evidence of osteomalacia.
- This highlights a potential complication of bariatric surgery.
Findings:
- The patient's osteomalacia was attributed to vitamin D deficiency secondary to RYGB.
- Aggressive calcium and vitamin D supplementation effectively corrected the deficiency.
- Treatment led to rapid improvement in clinical symptoms, biochemistry, and bone mineral density.
Implications:
- RYGB surgery carries a risk of developing metabolic bone disease.
- Osteomalacia must be considered in patients with low bone mineral density post-RYGB.
- Proper diagnosis and supplementation are vital before initiating treatments like bisphosphonates.