Incidence and risk factors of osteoporotic status in outpatients who underwent gastrectomy for gastric cancer

Abstract

Background and Aim: Disorders in bone metabolism have long been recognized as typical sequelae of gastrectomy; however, the pathogenesis has not been fully elucidated, resulting in a variation of reported incidence. This study aimed to evaluate current bone health by measuring bone mineral density (BMD) in patients treated by gastrectomy for gastric cancer, with a focus on incidence and risk factors of osteoporosis. Methods: The study enrolled 81 patients who underwent gastrectomy for gastric cancer at Kochi Medical School. BMD of the lumbar spine was measured by dual-energy X-ray mineral absorptiometry, with the results expressed as a percentage of the young adult mean (YAM). Clinical data were also obtained to investigate associations with BMD. Results: Of the 81 study patients, 12 (14.8%) were deemed to have osteoporosis, defined by a percentage of YAM <70, with a dominance of females over males (66.7% vs 17.4%; P < 0.001). The median body weight, hemoglobin concentration, and serum alkaline phosphatase (ALP) level of the patients with osteoporosis was significantly lower than in those with a percentage of YAM ≥70 group (39.6 kg vs 53.1 kg, P < 0.001; 10.9 mg/dL vs 12.5 mg/dL, P = 0.010; 210 U/L vs 251 U/L, P = 0.002). Further analyses revealed a significant positive correlation between body weight and percentage of YAM (r = 0.441, P < 0.001). Despite the administration of bisphosphonates in these patients during this study, one acquired a bone fracture. Conclusion: Osteoporosis was found in 14.8% of postoperative gastric cancer patients, with female gender, low body weight, and low ALP proposed as risk factors for osteoporosis and thus future bone fracture.

Bone Fragility in Gastrointestinal Disorders

“…With the increasing number of long-term survivors after gastrectomy, there has been increasing interest in the clinical management of post-gastrectomy syndromes and their possible complications. Among these complications, several reports indicated that patients with gastric cancer, and particularly gastric cancer survivors who underwent gastrectomy, have an increased risk of osteoporosis and fragility fractures [ 153 , 157 , 158 , 159 , 160 , 161 , 162 , 163 , 164 , 165 , 166 , 167 , 168 ]. This is in keeping with previous observations in patients with gastrectomy for peptic ulcer disease [ 169 ].…”

“…Likewise, the presence of complications, such as diabetes or dyslipidemia, as well as chemotherapy, have been associated with a higher risk of fracture after gastrectomy [ 163 ]. Anemia and a reduction in hemoglobin levels have been also linked to a higher risk of bone fragility in gastric cancer patients [ 167 , 168 ]. Although the underlying mechanism remains to be fully understood, it is likely that increased oxidative stress and extracellular acidification under hypoxic conditions might negatively affect bone remodeling, as also observed in the general population [ 180 , 181 ].…”

Association between Gastric Cancer and Osteoporosis: A Longitudinal Follow-Up Study Using a National Health Sample Cohort

“…Several studies on GC and osteoporosis or osteoporotic fractures have indicated that female sex, old age, and low body mass index are risk factors for developing osteoporosis. However, most studies were conducted at a single center, with a relatively small number of patients [12,[16][17][18][19]. Some studies included only men [20] or did not use matched controls [12,16,18,21].…”