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Bariatric surgery: Think about osteomalacia too.

Anastasia Mocritcaia1, Chafik Chacur1, Helena Flórez1,2

  • 1Rheumatology Department, Metabolic Bone Diseases Unit, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.

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Nearly 9% of patients with prior bariatric surgery (BS) may have osteomalacia, not just osteoporosis. Elevated total alkaline phosphatase (TAP) signals this condition, requiring specific high-dose calcium or parenteral vitamin D treatments.

Keywords:
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Area of Science:

  • Endocrinology
  • Bone Metabolism
  • Gastroenterology

Background:

  • Bariatric surgery (BS) is linked to osteoporosis and fractures.
  • Osteomalacia can develop post-BS and be misdiagnosed as osteoporosis.

Purpose of the Study:

  • To determine osteomalacia prevalence in patients with prior BS.
  • To identify clinical characteristics of these patients.

Main Methods:

  • Retrospective analysis of 46 patients with prior BS.
  • Diagnosis of osteomalacia based on bone biopsy or clinical criteria (low calcium/phosphate, elevated TAP, or radiology).

Main Results:

  • 8.7% of patients had osteomalacia, predominantly women post-malabsorptive surgery.
  • All showed elevated TAP and parathyroid hormone; most had hypocalcemia and low vitamin D.
  • Bone scans were consistent with osteomalacia; all had osteoporosis, many with fractures.

Conclusions:

  • Osteomalacia affects nearly 9% of osteoporosis patients with prior BS.
  • Elevated TAP is a key indicator for osteomalacia.
  • This diagnosis necessitates tailored treatment, potentially including high-dose calcium or parenteral vitamin D.