Impairment of vitamin D and bone metabolism in patients with bypass operation for obesity

Thirty-four patients were studied 2--6 years after jejunoileal bypass for morbid obesity. The serum concentration of 25-hydroxyvitamin D (25-OHD) were reduced and related to the frequency fo stools and to the weight reduction. Fifteen patients were not able to normalize serum 25-OHD following a long-term regular vitamin D intake. The serum immunoreactive parathyroid hormone concentration (iPTH) and the alkaline phosphatase levels were elevated in this group, indicating a secondary hyperparathyroidism. The mean bone mineral content of the forearm was reduced 3--6 years after the operation, most severely in those with elevated serum iPTH. The desired weight reduction by jejunoileal shunt was obtained at the expense of a severely disturbed vitamin D metabolism. We suggest, that all patients with an intestinal bypass for obesity should receive regular vitamin D supplement, and serum 25-OHD should be measured in order to monitor the effect of therapy.