The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer:​ a meta-analysis

Oh, H. J.; Yoon, B.-H.; Ha, Y.-C.; Suh, D.-C.; Lee, S.-M.; Koo, K.-H.; Lee, Y.-K.

Affiliations

¹Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection, National Cancer Center, Goyang-si, Republic of Korea

²Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea

³Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, Republic of Korea

⁴College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea

⁵College of Pharmacy, Daegu Catholic University, Gyeongsan-si,Gyeongbuk, Republic of Korea

⁶Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea

⁷Department of Orthopedic Surgery, Seoul National University College of Medicine, Seongnam-si, Republic of Korea

Abstract and keywords

Summary: Bone mineral density (BMD) is significantly decreased after gastrectomy in patients with gastric cancer. Calcium malabsorption, secondary hyperparathyroidism, and dominant bone resorption appear to contribute to bone loss in these patients. Patients should undergo early surveillance and nutritional or pharmacologic intensive interventions for bone health.

Purpose: Survivorship care, including bone health, has become an important issue in gastric cancer. We performed a meta-analysis of the available observational studies to determine whether and how osteoporosis risk is increased after gastrectomy in patients with gastric cancer.

Methods: A total of 1204 patients (802 men) from 19 cohort studies were included. We evaluated the prevalence of osteoporosis in postgastrectomy patients, comparing the incidence according to the type of gastrectomy and sex. Additionally, we evaluated changes in bone mineral density (BMD) and bone metabolism-related markers pre- to postoperatively and between patients who underwent gastrectomy and matched controls. Proportion meta-analysis was performed and pooled odds ratios (ORs) were calculated.

Results: The pooled incidence estimate was 36% [95% confidence interval (CI), 32–40]. The incidence of osteoporosis was significantly higher in women than in men (OR = 1.90, p < 0.001) but was similar between partial and total gastrectomy groups (OR = 0.983, p = 0.939). BMD was significantly decreased, and calcium, phosphorous, and parathyroid hormone levels were significantly increased in patients after gastrectomy compared to those before gastrectomy. BMD and calcium and 25OH-vitamin D levels were significantly decreased, and parathyroid hormone and 1,25OH-vitamin D levels were significantly increased in the gastrectomy group compared to that in the control group.

Conclusion: We found that BMD is significantly decreased after gastrectomy in patients with gastric cancer. Vitamin D deficiency and secondary hyperparathyroidism are suggested to be common mechanism underlying BMD impairment. After resection, patients should undergo long-term nutritional and bone health surveillance, in addition to their oncological follow-up.

Keywords: Bone mineral density; Gastrectomy; Gastric cancer; Osteoporosis; Parathyroid hormone; Vitamin D

Links

DOI: 10.1007/s00198-019-05220-2

PubMed: 31776636

WoS: 000498950600001

History

Received: 2019-06-27

Accepted: 2019-11-01

Online: 2019-11-27

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