VSG And Osteoporosis/Osteopenia

Hi All:

Many of you know that I'm hoping to have my Band revised to a VSG. For many Lap-Banders, it makes sense as a revision because it's restrictive only. Well, I've been researching it for about two years now, and recently found out (today!) that people who have gastrectomies, whether or not the intestines are rerouted, are at an increased risk for osteopenia and osteoporosis. They don't know why. There are a bunch of different theories out there.

I was kind of shocked to learn this, because I think we've all assumed that if they don't touch the intestines, then we don't have to worry about metabolic issues.

I know that some people here may be looking into the VSG, and I just wanted you to be aware of it. Please make sure that you do get your labs done, bone denity scans, etc.

Chirurg. 1997 Aug;68(8):784-8.Click here to read Links

[Calcium and bone metabolism after gastrectomy]

[Article in German]

Zittel TT, Maier GW, Starlinger M, Becker HD.

Abteilung für Allgemeinchirurgie, Chirurgische Universitätsklinik Tübingen.

Disturbances in calcium and bone metabolism after gastrectomy have long been recognized. It has been suggested that due to impaired calcium absorption after gastrectomy, serum calcium is decreased, being counter-regulated by parathyroid hormone release and 1,25-(OH)2-Vitamin D formation. Both parathyroid hormone and 1,25-(OH)2-Vitamin D are known to release calcium from bone, resulting in bone mass loss and increased fracture risk in some of the gastrectomized patients. No therapy is currently generally agreed on, although supplementation of vitamin D and calcium has been suggested repeatedly. A review on the current understanding of calcium and bone metabolism after gastrectomy is given.

PMID: 9377988 [PubMed - indexed for MEDLINE]

Am J Surg. 1997 Oct;174(4):431-8.Click here to read Links

High prevalence of bone disorders after gastrectomy.

Zittel TT, Zeeb B, Maier GW, Kaiser GW, Zwirner M, Liebich H, Starlinger M, Becker HD.

University Hospital, Department of Abdominal and Transplantation Surgery, Tübingen, Germany.

BACKGROUND: Studies indicate that gastrectomy might alter calcium and bone metabolism, resulting in bone disorders. No data are currently available on the prevalence of bone disorders after gastrectomy. METHODS: Sixty gastrectomy patients were investigated for serum parameters of calcium and bone metabolism 5 to 20 years postoperatively and compared to an age- and sex-matched healthy control population. Forty patients agreed to a radiological investigation of the spine by anterior-posterior and lateral radiographs of the thoracic and lumbar spine and by computed tomography (CT) osteodensitometry. RESULTS: Serum calcium and 25-(OH)-vitamin D were decreased in gastrectomized patients, while parathyroid hormone and 1,25-(OH)2-vitamin D were increased. Serum parameters of calcium metabolism were altered in as many as 68% of patients. We found 31 vertebral fractures in 13 patients, 30 grade 2 vertebral deformities in 18 patients, and osteopenia in 15 patients, corresponding to a prevalence of 33%, 45%, and 37% in gastrectomized patients, respectively. The overall rate of gastrectomy patients having vertebral fractures and/or osteopenia was 55%. The risk of having a vertebral deformity was increased by more than sixfold after gastrectomy. Our study is the first report evaluating vertebral deformities in gastrectomized patients, and the largest series of gastrectomized patients investigated by CT osteodensitometry. CONCLUSION: We found a high prevalence of bone disorders in gastrectomized patients, possibly resulting from disorders in calcium metabolism. Postgastrectomy bone disease might derive from a calcium deficit, which increases calcium release from bone and impairs calcification of newly build bone matrix.

PMID: 9337169 [PubMed - indexed for MEDLINE]

Bone. 2007 Sep;41(3):406-13. Epub 2007 May 31.

Lack of an acute effect of ghrelin on markers of bone turnover in healthy controls and post-gastrectomy subjects.

Huda MS, Durham BH, Wong SP, Dovey TM, McCulloch P, Kerrigan D, Pinkney JH, Fraser WD, Wilding JP.

Clinical Sciences Centre, University of Liverpool Diabetes and Endocrinology Research Group, University Hospital Aintree, Longmoor lane, Liverpool L9 7AL, UK.

BACKGROUND: Ghrelin is a gut-brain peptide that powerfully stimulates appetite and growth hormone secretion and is also known to directly regulate osteoblast cell function in vitro and in animal models. Little is known about the effects of ghrelin on bone turnover in humans. As the stomach is the main site of ghrelin synthesis, gastrectomy patients are deficient in ghrelin; they are also prone to osteopenia and osteomalacia. HYPOTHESIS: Ghrelin may play a role in bone regulation in humans; ghrelin deficiency following gastrectomy is associated with the disrupted regulation of bone turnover seen in these subjects. SUBJECTS AND METHODS: In a randomised, double-blind, placebo-controlled study 8 healthy controls and 8 post-gastrectomy subjects were infused with intravenous ghrelin (5 pmol/kg/min) or saline over 240 min on different days. Subjects were given a fixed energy meal during the infusion. Ghrelin, GH, type-1 collagen beta C-telopeptide (betaCTX), a marker of bone resorption, and procollagen type-1 amino-terminal propeptide (P1NP), a marker of bone formation, were measured. RESULTS: Fasting ghrelin was significantly lower in the gastrectomy group during the saline infusion (226.1+/-62.0 vs. 762+/-71.1 ng/l p<0.001). Growth hormone was significantly higher at 90 min after the ghrelin infusion, compared to saline in both healthy controls (61.1+/-8.8 vs. 1.4+/-0.6 mIU/l p<0.001) and gastrectomy subjects (61.1+/-11.8 vs. 0.9+/-0.2 mIU/l p<0.001) confirming the ghrelin was bioactive. Gastrectomy subjects were significantly older and had significantly higher plasma betaCTX than healthy controls at all time points (ANOVA p=0.009). After adjustment for age and BMI ghrelin was found to be a significant predictor of baseline plasma betaCTX and was inversely correlated with baseline plasma betaCTX (beta=-0.54 p=0.03 R2=26%). However, there was no significant effect of the ghrelin infusion on plasma betaCTX or P1NP in either subject group. CONCLUSIONS: Ghrelin infusion has no acute effect on markers of bone turnover in healthy controls and post-gastrectomy subjects, but is inversely correlated with bone resorption.

PMID: 17613297 [PubMed - indexed for MEDLINE]