Post-gastrectomy nutrition: methods of outpatient screening for early osteomalacia

A cohort of 227 patients treated by partial gastrectomy between 1955-1960 has been followed up regularly for evidence of osteomalacia. Of these, 10 developed clinical or subclinical osteomalacia as proven by bone biopsy. The diagnosis of early asymptomatic osteomalacia in bone biopsies presented many difficulties. As an alternative, patients with a rising serum alkaline phosphatase (SAP) were screened for liver disease, Paget's disease, osteoporotic crush fractures and bony secondaries. In the absence of these a therapeutic trial of eight Calcium and Vitamin D tablets BPC daily was given. In 5 out of 11 patients the SAP fell to normal and these were given a maintenance daily dose of six tablets. These patients were presumed to have had subclinical osteomalacia. This approach, involving regular monitoring of the SAP, is recommended as the most applicable for routine screening of a gastrectomy population, particularly in District Hospitals.