Hypocalcemia and osteomalacia after bariatric surgery

Area of Science:

• Endocrinology
• Gastroenterology
• Orthopedics

Background:

• Obesity is a global health crisis, with bariatric surgery increasingly used for weight management and comorbidity reduction.
• Post-bariatric surgery anatomical and physiological changes can significantly impair the intestinal absorption of essential nutrients like vitamin D and calcium, crucial for bone health.

Purpose of the Study:

• To highlight the potential long-term bone and mineral health consequences following bariatric surgery.
• To emphasize the necessity of vigilant and proactive patient follow-up after bariatric procedures.

Main Methods:

• A case report of a 48-year-old female presenting with symptoms of severe bone pain, perioral paresthesia, and carpopedal spasm.
• Clinical examination revealed positive Chvostek's and Trousseau's signs and severe rib pain on palpation.
• Laboratory findings indicated significant hypocalcemia, hypophosphatemia, elevated alkaline phosphatase, high parathyroid hormone, and severely low vitamin D levels (25(OH)D3 = 3 ng/mL).

Main Results:

• The patient, who had undergone bariatric surgery 15 years prior, presented with classic signs of severe mineral deficiency.
• Bone scan demonstrated increased uptake in ribs and costochondral joints, indicative of metabolic bone disease.
• The diagnostic findings correlated with impaired calcium and vitamin D absorption post-bariatric surgery.

Conclusions:

• This case underscores the potential for bariatric surgery to negatively impact bone and mineral metabolism.
• Regular and proactive monitoring of bone health in patients who have undergone bariatric surgery is essential to detect and manage potential complications.