Risk factors for loss of bone mineral density after curative esophagectomy
Summary Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surge...
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| Veröffentlicht in: | Archives of Osteoporosis 2019-01, Vol.14 (1), p.6-6, Article 6 |
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| creator | Elliott, Jessie A. Casey, Sean Murphy, Conor F. Docherty, Neil G. Ravi, Narayanasamy Beddy, Peter Reynolds, John V. le Roux, Carel W. |
| description | Summary
Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.
Purpose
Improved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.
Methods
Consecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.
Results
Seventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2 years postoperatively (144.3 ± 45.8 versus 128.6 ± 46.2 and 122.7 ± 43.5 Hounsfield Units (HU),
P
|
| doi_str_mv | 10.1007/s11657-018-0556-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179313461</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2179313461</sourcerecordid><originalsourceid>FETCH-LOGICAL-c481t-adaa675253f5bfd34100be9a3e3d196371899a4f82e51bd446c91803c1b871b03</originalsourceid><addsrcrecordid>eNp9kE1P7CAUhonR-P0D3NywdFPlQKF0eWOuXzExMbomtD2M9balQquZ-fViZpylK044z_sGHkLOgF0AY8VlBFCyyBjojEmpstUOOQSteCYk5LvbmfMDchTjG2OKgVT75EAwxQut1SG5f2rjf-psPfkQqfOBdj5G6h2t_IC0bwcMtqMNDrGdltS6CQOt52Cn9gMpRj--2gWmdL88IXvOdhFPN-cxebn-93x1mz083txd_X3I6lzDlNnGWlVILoWTlWtEnr5SYWkFigZKJQrQZWlzpzlKqJo8V3UJmokaKl1AxcQxyda98RPHuTJjaHsblsbb1izm0aSrxWwiGl6okpeJP1_zY_DvM8bJ9G2ssevsgH6OhkNRChC5goTCGq1DshDQbcuBmW_lZq3cJOXmW7lZpcyfTf1c9dhsEz-OE8A3702rYYHBvPk5DEnRL61fLkiNBQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2179313461</pqid></control><display><type>article</type><title>Risk factors for loss of bone mineral density after curative esophagectomy</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Elliott, Jessie A. ; Casey, Sean ; Murphy, Conor F. ; Docherty, Neil G. ; Ravi, Narayanasamy ; Beddy, Peter ; Reynolds, John V. ; le Roux, Carel W.</creator><creatorcontrib>Elliott, Jessie A. ; Casey, Sean ; Murphy, Conor F. ; Docherty, Neil G. ; Ravi, Narayanasamy ; Beddy, Peter ; Reynolds, John V. ; le Roux, Carel W.</creatorcontrib><description>Summary
Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.
Purpose
Improved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.
Methods
Consecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.
Results
Seventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2 years postoperatively (144.3 ± 45.8 versus 128.6 ± 46.2 and 122.7 ± 43.5 Hounsfield Units (HU),
P
< 0.0001), with increased osteoporosis prevalence to 38% and 44% (
P
= 0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (
P
< 0.001). While female sex (
P
= 0.004) and ASA grade (
P
= 0.043) were independently associated with osteoporosis at diagnosis, age (
P
= 0.050), female sex (
P =
0.023), smoking (
P
= 0.024), and pathologic T stage (
P
= 0.023) were independently predictive of osteoporosis at 1 year postoperatively.
Conclusions
Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.</description><identifier>ISSN: 1862-3522</identifier><identifier>EISSN: 1862-3514</identifier><identifier>DOI: 10.1007/s11657-018-0556-z</identifier><identifier>PMID: 30627886</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>1993 ; acidity ; Aged ; Bone ; Bone Density ; Bone mineral density ; calcium-absorption ; chemoradiotherapy ; Clinical Medicine ; digestion ; Endocrinology ; Endocrinology & Metabolism ; Esophageal cancer ; Esophageal Neoplasms - physiopathology ; Esophageal Neoplasms - surgery ; Esophagectomy ; Esophagectomy - adverse effects ; Female ; gastrectomy ; gastric bypass-surgery ; holic j ; Humans ; Klinisk medicin ; Malabsorption ; Male ; Malnutrition ; Medicine ; Medicine & Public Health ; metabolism ; Middle Aged ; Nutritional Status ; Original Article ; Orthopaedics ; Orthopedics ; Ortopedi ; Osteoporosis - epidemiology ; Osteoporosis - etiology ; p73 ; post-esophagectomy ; Postoperative Complications - epidemiology ; Postoperative Complications - etiology ; Prevalence ; proton pump inhibitors ; quality-of-life ; Risk Factors ; Tomography, X-Ray Computed - methods ; v54</subject><ispartof>Archives of Osteoporosis, 2019-01, Vol.14 (1), p.6-6, Article 6</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c481t-adaa675253f5bfd34100be9a3e3d196371899a4f82e51bd446c91803c1b871b03</citedby><cites>FETCH-LOGICAL-c481t-adaa675253f5bfd34100be9a3e3d196371899a4f82e51bd446c91803c1b871b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11657-018-0556-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11657-018-0556-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30627886$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://gup.ub.gu.se/publication/276929$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Elliott, Jessie A.</creatorcontrib><creatorcontrib>Casey, Sean</creatorcontrib><creatorcontrib>Murphy, Conor F.</creatorcontrib><creatorcontrib>Docherty, Neil G.</creatorcontrib><creatorcontrib>Ravi, Narayanasamy</creatorcontrib><creatorcontrib>Beddy, Peter</creatorcontrib><creatorcontrib>Reynolds, John V.</creatorcontrib><creatorcontrib>le Roux, Carel W.</creatorcontrib><title>Risk factors for loss of bone mineral density after curative esophagectomy</title><title>Archives of Osteoporosis</title><addtitle>Arch Osteoporos</addtitle><addtitle>Arch Osteoporos</addtitle><description>Summary
Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.
Purpose
Improved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.
Methods
Consecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.
Results
Seventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2 years postoperatively (144.3 ± 45.8 versus 128.6 ± 46.2 and 122.7 ± 43.5 Hounsfield Units (HU),
P
< 0.0001), with increased osteoporosis prevalence to 38% and 44% (
P
= 0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (
P
< 0.001). While female sex (
P
= 0.004) and ASA grade (
P
= 0.043) were independently associated with osteoporosis at diagnosis, age (
P
= 0.050), female sex (
P =
0.023), smoking (
P
= 0.024), and pathologic T stage (
P
= 0.023) were independently predictive of osteoporosis at 1 year postoperatively.
Conclusions
Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.</description><subject>1993</subject><subject>acidity</subject><subject>Aged</subject><subject>Bone</subject><subject>Bone Density</subject><subject>Bone mineral density</subject><subject>calcium-absorption</subject><subject>chemoradiotherapy</subject><subject>Clinical Medicine</subject><subject>digestion</subject><subject>Endocrinology</subject><subject>Endocrinology & Metabolism</subject><subject>Esophageal cancer</subject><subject>Esophageal Neoplasms - physiopathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophagectomy</subject><subject>Esophagectomy - adverse effects</subject><subject>Female</subject><subject>gastrectomy</subject><subject>gastric bypass-surgery</subject><subject>holic j</subject><subject>Humans</subject><subject>Klinisk medicin</subject><subject>Malabsorption</subject><subject>Male</subject><subject>Malnutrition</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>metabolism</subject><subject>Middle Aged</subject><subject>Nutritional Status</subject><subject>Original Article</subject><subject>Orthopaedics</subject><subject>Orthopedics</subject><subject>Ortopedi</subject><subject>Osteoporosis - epidemiology</subject><subject>Osteoporosis - etiology</subject><subject>p73</subject><subject>post-esophagectomy</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - etiology</subject><subject>Prevalence</subject><subject>proton pump inhibitors</subject><subject>quality-of-life</subject><subject>Risk Factors</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>v54</subject><issn>1862-3522</issn><issn>1862-3514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P7CAUhonR-P0D3NywdFPlQKF0eWOuXzExMbomtD2M9balQquZ-fViZpylK044z_sGHkLOgF0AY8VlBFCyyBjojEmpstUOOQSteCYk5LvbmfMDchTjG2OKgVT75EAwxQut1SG5f2rjf-psPfkQqfOBdj5G6h2t_IC0bwcMtqMNDrGdltS6CQOt52Cn9gMpRj--2gWmdL88IXvOdhFPN-cxebn-93x1mz083txd_X3I6lzDlNnGWlVILoWTlWtEnr5SYWkFigZKJQrQZWlzpzlKqJo8V3UJmokaKl1AxcQxyda98RPHuTJjaHsblsbb1izm0aSrxWwiGl6okpeJP1_zY_DvM8bJ9G2ssevsgH6OhkNRChC5goTCGq1DshDQbcuBmW_lZq3cJOXmW7lZpcyfTf1c9dhsEz-OE8A3702rYYHBvPk5DEnRL61fLkiNBQ</recordid><startdate>20190109</startdate><enddate>20190109</enddate><creator>Elliott, Jessie A.</creator><creator>Casey, Sean</creator><creator>Murphy, Conor F.</creator><creator>Docherty, Neil G.</creator><creator>Ravi, Narayanasamy</creator><creator>Beddy, Peter</creator><creator>Reynolds, John V.</creator><creator>le Roux, Carel W.</creator><general>Springer London</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>F1U</scope></search><sort><creationdate>20190109</creationdate><title>Risk factors for loss of bone mineral density after curative esophagectomy</title><author>Elliott, Jessie A. ; Casey, Sean ; Murphy, Conor F. ; Docherty, Neil G. ; Ravi, Narayanasamy ; Beddy, Peter ; Reynolds, John V. ; le Roux, Carel W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c481t-adaa675253f5bfd34100be9a3e3d196371899a4f82e51bd446c91803c1b871b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>1993</topic><topic>acidity</topic><topic>Aged</topic><topic>Bone</topic><topic>Bone Density</topic><topic>Bone mineral density</topic><topic>calcium-absorption</topic><topic>chemoradiotherapy</topic><topic>Clinical Medicine</topic><topic>digestion</topic><topic>Endocrinology</topic><topic>Endocrinology & Metabolism</topic><topic>Esophageal cancer</topic><topic>Esophageal Neoplasms - physiopathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophagectomy</topic><topic>Esophagectomy - adverse effects</topic><topic>Female</topic><topic>gastrectomy</topic><topic>gastric bypass-surgery</topic><topic>holic j</topic><topic>Humans</topic><topic>Klinisk medicin</topic><topic>Malabsorption</topic><topic>Male</topic><topic>Malnutrition</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>metabolism</topic><topic>Middle Aged</topic><topic>Nutritional Status</topic><topic>Original Article</topic><topic>Orthopaedics</topic><topic>Orthopedics</topic><topic>Ortopedi</topic><topic>Osteoporosis - epidemiology</topic><topic>Osteoporosis - etiology</topic><topic>p73</topic><topic>post-esophagectomy</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - etiology</topic><topic>Prevalence</topic><topic>proton pump inhibitors</topic><topic>quality-of-life</topic><topic>Risk Factors</topic><topic>Tomography, X-Ray Computed - methods</topic><topic>v54</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elliott, Jessie A.</creatorcontrib><creatorcontrib>Casey, Sean</creatorcontrib><creatorcontrib>Murphy, Conor F.</creatorcontrib><creatorcontrib>Docherty, Neil G.</creatorcontrib><creatorcontrib>Ravi, Narayanasamy</creatorcontrib><creatorcontrib>Beddy, Peter</creatorcontrib><creatorcontrib>Reynolds, John V.</creatorcontrib><creatorcontrib>le Roux, Carel W.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Göteborgs universitet</collection><jtitle>Archives of Osteoporosis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elliott, Jessie A.</au><au>Casey, Sean</au><au>Murphy, Conor F.</au><au>Docherty, Neil G.</au><au>Ravi, Narayanasamy</au><au>Beddy, Peter</au><au>Reynolds, John V.</au><au>le Roux, Carel W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for loss of bone mineral density after curative esophagectomy</atitle><jtitle>Archives of Osteoporosis</jtitle><stitle>Arch Osteoporos</stitle><addtitle>Arch Osteoporos</addtitle><date>2019-01-09</date><risdate>2019</risdate><volume>14</volume><issue>1</issue><spage>6</spage><epage>6</epage><pages>6-6</pages><artnum>6</artnum><issn>1862-3522</issn><eissn>1862-3514</eissn><abstract>Summary
Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.
Purpose
Improved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.
Methods
Consecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.
Results
Seventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2 years postoperatively (144.3 ± 45.8 versus 128.6 ± 46.2 and 122.7 ± 43.5 Hounsfield Units (HU),
P
< 0.0001), with increased osteoporosis prevalence to 38% and 44% (
P
= 0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (
P
< 0.001). While female sex (
P
= 0.004) and ASA grade (
P
= 0.043) were independently associated with osteoporosis at diagnosis, age (
P
= 0.050), female sex (
P =
0.023), smoking (
P
= 0.024), and pathologic T stage (
P
= 0.023) were independently predictive of osteoporosis at 1 year postoperatively.
Conclusions
Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.</abstract><cop>London</cop><pub>Springer London</pub><pmid>30627886</pmid><doi>10.1007/s11657-018-0556-z</doi><tpages>1</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Archives of Osteoporosis, 2019-01, Vol.14 (1), p.6-6, Article 6 |
| issn | 1862-3522 1862-3514 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2179313461 |
| source | MEDLINE; SpringerLink Journals |
| subjects | 1993 acidity Aged Bone Bone Density Bone mineral density calcium-absorption chemoradiotherapy Clinical Medicine digestion Endocrinology Endocrinology & Metabolism Esophageal cancer Esophageal Neoplasms - physiopathology Esophageal Neoplasms - surgery Esophagectomy Esophagectomy - adverse effects Female gastrectomy gastric bypass-surgery holic j Humans Klinisk medicin Malabsorption Male Malnutrition Medicine Medicine & Public Health metabolism Middle Aged Nutritional Status Original Article Orthopaedics Orthopedics Ortopedi Osteoporosis - epidemiology Osteoporosis - etiology p73 post-esophagectomy Postoperative Complications - epidemiology Postoperative Complications - etiology Prevalence proton pump inhibitors quality-of-life Risk Factors Tomography, X-Ray Computed - methods v54 |
| title | Risk factors for loss of bone mineral density after curative esophagectomy |
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