Preview

Problems of Endocrinology

Advanced search

The development of severe osteomalacia following biliopancreatic diversion surgery for the management of morbid obesity

https://doi.org/10.14341/probl201258316-21

Abstract

Biliopancreatic diversion (BPD) surgery is one of the most efficacious bariatric procedures employed to manage morbid obesity. However, apart from a stable reduction of the body weight and beneficial action on the clinical course of various diseases associated with obesity, this method creates the risk of inducing osteometabolic disorders following the surgical intervention. We present here a clinical case of osteomalacia that developed in the late post-BPD period in the absence of regular intake of medicines and adequate medical care.

References

1. Dixon J.B., Pories W.J., O'Brien P.E. et al. Surgery as an effective early intervention for diabesity: why the reluctanceα Diabetes Care 2005; 28: 472-474.

2. Santry H.P., Gillen D.L., Lauderdale D.S. Trends in bariatric surgical procedures. J Am Med Ass 2005; 294: 1909-1917.

3. de Prisco C., Levine S.N. Metabolic bone disease after gastric bypass surgery for obesity. Am J Med Sci 2005; 329: 57-61.

4. Goode L.R., Brolin R.E., Chowdhury H.A. et al. Bone and gastric bypass surgery: effects of dietary calcium and vitamin D. Obes Res 2004; 12: 40-47.

5. Eddy L. Metabolic bone disease after gastrectomy. Am J Med 1971; 50: 4: 442-449.

6. Atreja A., Abacan C., Licata A. A 51-year-old woman with debilitating cramps 12 years after bariatric surgery. Cleveland Clin J Med 2003; 70: 5: 417-426.

7. Collazo-Clavell M.L, Jimenez A., Hodgson S.F. et al. Osteomalacia after Roux-en-Y gastric bypass. Endocrine Pract 2004; 10: 3: 287-288.

8. Goldner S., O'Dorisio T.M., Dillon J.S. et al. Severemetabolic bone disease as a long-termcomplication of obesity surgery. Obes Surg 2002; 12: 685-692.

9. Haria D.M., Sibonga J.D., Taylor H.C. Hypocalcemia, hypovitaminosis D osteopathy, osteopenia, and secondary hyperparathyroidism 32 years after jejunoileal bypass. Endocrine Pract 2005; 11: 5: 335-340.

10. Parikh S.J., Edelman M., Uwaifo G.I. et al. Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metabol 2004; 89: 1196-1199.

11. Williams S.E., Licata A.A. Severemetabolic bone disease in a 76-year-old woman thirty-three years after bariatric surgery. J Clin Densitometry 2008; 11: 3: 459.

12. Hamoui N., Kim K., Anthone G. et al. The significance of elevated levels of parathyroid hormone in patients with morbid obesity before and after bariatric surgery. Arch Surg 2003; 138: 891-897.

13. Crowley L.V., Seay J., Mullin G. Late effects of gastric bypass for obesity. Am J Gastroenterol 1984; 79: 850-860.

14. Friedman J.E., Dallal R.M., Lord J.L. Gouty attacks occur frequently in postoperative gastric bypass patients. Surg Obes Relat Dis 2008; 4: 11-13.

15. Ott M.T., Fanti P., Malluche H.H. et al. Biochemical evidence of metabolic bone disease in women following Roux-Y gastric bypass for morbid obesity. Obes Surg 1992; 2: 341-348.

16. Pugnale N., Giusti V., Suter M. et al. Bone metabolism and risk of secondary hyperparathyroidism 12 months after gastric banding in obese premenopausal women. Int J Obes Relat Metab Dis 2003; 27: 110-116.

17. Shaker J.L., Norton A.J., Woods M.F. et al. Secondary hyperparathyroidism and osteopenia in women following gastric exclusion surgery for obesity. Osteopor Int 1991; 1: 177-181.

18. Bloomberg R.D., Fleishman A., Nalle J.E. et al. Nutritional deficiencies following bariatric surgery: what have we learned? Obes Surg 2005; 15: 145-154.

19. Brolin R.E., LaMarca L.B., Kenler H.A. et al. Malabsorptive gastric bypass in patients with superobesity. J Gastrointest Surg 2002; 6: 195-205.

20. Dolan K., Hatzifotis M., Newbury L. et al. Acomparison of laparoscopic adjustable gastric banding and biliopancreatic diversion in superobesity. Obes Surg 2004; 14: 165-169.

21. Newbury L., Dolan K., Hatzifotis M. et al. Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion. Obes Surg 2003; 13: 893-895.

22. Slater G.H., Ren C.J., Siegel N. et al. Serum fat soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55.

23. Balsa J.A., Botella-Carretero J.I., Peromingo R. et al. Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. J Endocrinol Invest 2008; 31: 845-850.

24. Carlin A.M., Rao D.S., Yager K.M. et al. Effect of gastric bypass surgery on vitamin D nutritional status. Surg Obes Relat Dis 2006; 2: 638-642.

25. Diniz M. de F., Diniz M.T., Sanches S.R. et al. Elevated serum parathormone after Roux-en-Y gastric bypass. Obes Surg 2004; 14: 1222-1226.

26. Johnson J.M., Maher J.W., DeMaria E.J. et al. The Long-term Effects of Gastric Bypass on Vitamin D Metabolism. Ann Surg 2006; 243: 701-705.

27. Sanchez-Hernandez J., Ybarra J., Gich I. et al. Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study. Obes Res 2005; 15: 1389-1395.

28. Manco M., Calvani M., Nanni G. et al. Low 25-hydroxyvitamin D does not affect insulin sensitivity in obesity after bariatric surgery. Obes Res 2005; 13: 1692-700.

29. Youssef Y., Richards W.O., Sekhar N.A. et al. Risk of secondary hyperparathyroidism after laparoscopic gastric bypass surgery in obese women. Surg Endosc 2007; 21: 1393-1396.

30. Kamycheva E., Sundsfjord J., Jorde R. Serum parathyroid hormone level is associated with body mass index. The 5th Tromso study. Eur J Endocrinol 2004; 151: 167-172.

31. Puzziferri N., Blankenship J., Wolfe B.M. Surgical treatment of obesity. Endocrine 2006; 29: 1: 11-19.

32. Blake G.M., Fogelman I. How important are BMD accuracy errors for the clinical interpretation of DXA scans? J Bone Min Res 2008; 23: 4: 457-462.

33. Carlin A.M., Rao D.S., Meslemani A.M. et al. Prevalenceof vitamin D depletion among morbidly obese patients seeking gastric bypass surgery. Surg Obes Relat Dis 2006; 2: 2: 98-103.

34. Duffey B.G., Pedro R.N., Makhlouf A. et al. Roux-en-Y gastric bypass is associated with early increased risk for development of calcium oxalate nephrolithiasis. J Am Coll Surg 2008; 206: 6: 1145-1153.

35. Sinha M.K., Collazo-Clavell M.L, Rule A. et al. Hyperoxaluric nephrolithiasis is a complication of Roux-en-Y gastric bypass surgery. Kidney Int 2007; 72: 1: 100-107.

36. Brethauer S.A., Chand B., Schauer P.R. Risks andbenefits of bariatric surgery: current evidence. Clev Clin J Med 2006; 73: 11: 993-1007.

37. Hensrud D.D., McMahon M.M. Bariatric surgery in adults with extreme (not morbid) obesity. Mayo Clin Proceedings 2006; 81: Suppl 10: S3-S4.

38. Mason M.E., Jalagani H., Vinik A.I. Metabolic complications of bariatric surgery: diagnosis andmanagement issues. Gastroent Clin North Am 2005; 34: 1: 25-33.

39. McGlinch B.P., Que F.G., Nelson J.L. et al. Perioperative care of patients undergoing bariatric surgery. Mayo Clin Proceedings 2006; 81: 10: S25-S33.

40. Mechanick J.I., Kushner R.F., Sugerman H.J. et al. AACE/TOS/ASMBS Guidelines. Surg Obes Relat Dis 2008; 4: S109-S184.

41. Cannell J., Hollis B. Use of vitamin D in clinical practice. Alternat Med Rev 2008; 13: 6-20.

42. Cannell J., Hollis B., Zasloff M. et al. Diagnosis and treatment of vitamin D deficiency. Exp Opin Pharmacother 2008; 9: 107-118.

43. Heber D., Greenway F.L., Kaplan L.M. et al. Endocrine and Nutritional Management of the Post-Bariatric Surgery Patient: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2010; 95: 11: 4823-4843.


Review

For citations:


Mel'nichenko G.A., Troshina E.A., Mazurina N.V., Ogneva N.A., Iashkov I.I. The development of severe osteomalacia following biliopancreatic diversion surgery for the management of morbid obesity. Problems of Endocrinology. 2012;58(3):16-21. https://doi.org/10.14341/probl201258316-21

Views: 547


ISSN 0375-9660 (Print)
ISSN 2308-1430 (Online)