The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis
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 nutr...
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| Veröffentlicht in: | Osteoporosis international 2020-02, Vol.31 (2), p.267-275 |
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| creator | Oh, H.J. Yoon, B.-H. Ha, Y.-C. Suh, D.-C. Lee, S.-M. Koo, K.-H. Lee, Y.-K. |
| description | 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. |
| doi_str_mv | 10.1007/s00198-019-05220-2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2319494358</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2352900000</sourcerecordid><originalsourceid>FETCH-LOGICAL-c469t-d4f4d77aa796346a2e29bf5127d1bacf387995dae8abe801a874430bc0c5d37c3</originalsourceid><addsrcrecordid>eNp9kU1LxDAQhoMouq7-AQ8S8OIlms-m8SbiFwheFLyVaTrVStto0j3svze6q4IHc5gQ5nnfzPASciD4ieDcnibOhStZLowbKTmTG2QmtFJMusJskhl3yjKnxdMO2U3plWeRc3ab7ChhbVGoYkb6hxek_gXGZ6ShpXUYkQ7diBF62uCYumlJYWzWDZygDn2XBgrthJE-Q5oi-ikMS9qG9bvz1MPoMZ5R-JIwGKFfpi7tka0W-oT763tOHq8uHy5u2N399e3F-R3zunATa3SrG2sBrCuULkCidHVrhLSNqMG3qsxrmAawhBpLLqC0Witee-5No6xXc3K88n2L4X2BaaqGLnnsexgxLFIllXDaaWXKjB79QV_DIuZ5M6WtMIUolfmXUkY6_nkyJVeUjyGliG31FrsB4rISvPpMrFolVuVSfSWW1XNyuLZe1AM2P5LviDKgVkDKrRxT_P37H9sPOGOgiw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2352900000</pqid></control><display><type>article</type><title>The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Oh, H.J. ; Yoon, B.-H. ; Ha, Y.-C. ; Suh, D.-C. ; Lee, S.-M. ; Koo, K.-H. ; Lee, Y.-K.</creator><creatorcontrib>Oh, H.J. ; Yoon, B.-H. ; Ha, Y.-C. ; Suh, D.-C. ; Lee, S.-M. ; Koo, K.-H. ; Lee, Y.-K.</creatorcontrib><description>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.</description><identifier>ISSN: 0937-941X</identifier><identifier>EISSN: 1433-2965</identifier><identifier>DOI: 10.1007/s00198-019-05220-2</identifier><identifier>PMID: 31776636</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Bone cancer ; Bone Density ; Bone loss ; Bone mineral density ; Bone resorption ; Bone turnover ; Calcium ; Endocrinology ; Female ; Gastrectomy ; Gastrectomy - adverse effects ; Gastric cancer ; Health surveillance ; Humans ; Hyperparathyroidism ; Long bone ; Malabsorption ; Male ; Medicine ; Medicine & Public Health ; Meta-analysis ; Metabolism ; Nutrient deficiency ; Original Article ; Orthopedics ; Osteoporosis ; Osteoporosis - epidemiology ; Osteoporosis - etiology ; Parathyroid ; Parathyroid Hormone ; Rheumatology ; Stomach Neoplasms - surgery ; Surveillance ; Survival ; Vitamin D ; Vitamin deficiency</subject><ispartof>Osteoporosis international, 2020-02, Vol.31 (2), p.267-275</ispartof><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2019</rights><rights>Osteoporosis International is a copyright of Springer, (2019). All Rights Reserved.</rights><rights>International Osteoporosis Foundation and National Osteoporosis Foundation 2019.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c469t-d4f4d77aa796346a2e29bf5127d1bacf387995dae8abe801a874430bc0c5d37c3</citedby><cites>FETCH-LOGICAL-c469t-d4f4d77aa796346a2e29bf5127d1bacf387995dae8abe801a874430bc0c5d37c3</cites><orcidid>0000-0001-6564-4294 ; 0000-0001-9373-9135</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00198-019-05220-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00198-019-05220-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,777,781,27905,27906,41469,42538,51300</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31776636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Oh, H.J.</creatorcontrib><creatorcontrib>Yoon, B.-H.</creatorcontrib><creatorcontrib>Ha, Y.-C.</creatorcontrib><creatorcontrib>Suh, D.-C.</creatorcontrib><creatorcontrib>Lee, S.-M.</creatorcontrib><creatorcontrib>Koo, K.-H.</creatorcontrib><creatorcontrib>Lee, Y.-K.</creatorcontrib><title>The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis</title><title>Osteoporosis international</title><addtitle>Osteoporos Int</addtitle><addtitle>Osteoporos Int</addtitle><description>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.</description><subject>Bone cancer</subject><subject>Bone Density</subject><subject>Bone loss</subject><subject>Bone mineral density</subject><subject>Bone resorption</subject><subject>Bone turnover</subject><subject>Calcium</subject><subject>Endocrinology</subject><subject>Female</subject><subject>Gastrectomy</subject><subject>Gastrectomy - adverse effects</subject><subject>Gastric cancer</subject><subject>Health surveillance</subject><subject>Humans</subject><subject>Hyperparathyroidism</subject><subject>Long bone</subject><subject>Malabsorption</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Metabolism</subject><subject>Nutrient deficiency</subject><subject>Original Article</subject><subject>Orthopedics</subject><subject>Osteoporosis</subject><subject>Osteoporosis - epidemiology</subject><subject>Osteoporosis - etiology</subject><subject>Parathyroid</subject><subject>Parathyroid Hormone</subject><subject>Rheumatology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surveillance</subject><subject>Survival</subject><subject>Vitamin D</subject><subject>Vitamin deficiency</subject><issn>0937-941X</issn><issn>1433-2965</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU1LxDAQhoMouq7-AQ8S8OIlms-m8SbiFwheFLyVaTrVStto0j3svze6q4IHc5gQ5nnfzPASciD4ieDcnibOhStZLowbKTmTG2QmtFJMusJskhl3yjKnxdMO2U3plWeRc3ab7ChhbVGoYkb6hxek_gXGZ6ShpXUYkQ7diBF62uCYumlJYWzWDZygDn2XBgrthJE-Q5oi-ikMS9qG9bvz1MPoMZ5R-JIwGKFfpi7tka0W-oT763tOHq8uHy5u2N399e3F-R3zunATa3SrG2sBrCuULkCidHVrhLSNqMG3qsxrmAawhBpLLqC0Witee-5No6xXc3K88n2L4X2BaaqGLnnsexgxLFIllXDaaWXKjB79QV_DIuZ5M6WtMIUolfmXUkY6_nkyJVeUjyGliG31FrsB4rISvPpMrFolVuVSfSWW1XNyuLZe1AM2P5LviDKgVkDKrRxT_P37H9sPOGOgiw</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Oh, H.J.</creator><creator>Yoon, B.-H.</creator><creator>Ha, Y.-C.</creator><creator>Suh, D.-C.</creator><creator>Lee, S.-M.</creator><creator>Koo, K.-H.</creator><creator>Lee, Y.-K.</creator><general>Springer London</general><general>Springer Nature B.V</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>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6564-4294</orcidid><orcidid>https://orcid.org/0000-0001-9373-9135</orcidid></search><sort><creationdate>20200201</creationdate><title>The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis</title><author>Oh, H.J. ; Yoon, B.-H. ; Ha, Y.-C. ; Suh, D.-C. ; Lee, S.-M. ; Koo, K.-H. ; Lee, Y.-K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c469t-d4f4d77aa796346a2e29bf5127d1bacf387995dae8abe801a874430bc0c5d37c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bone cancer</topic><topic>Bone Density</topic><topic>Bone loss</topic><topic>Bone mineral density</topic><topic>Bone resorption</topic><topic>Bone turnover</topic><topic>Calcium</topic><topic>Endocrinology</topic><topic>Female</topic><topic>Gastrectomy</topic><topic>Gastrectomy - adverse effects</topic><topic>Gastric cancer</topic><topic>Health surveillance</topic><topic>Humans</topic><topic>Hyperparathyroidism</topic><topic>Long bone</topic><topic>Malabsorption</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Metabolism</topic><topic>Nutrient deficiency</topic><topic>Original Article</topic><topic>Orthopedics</topic><topic>Osteoporosis</topic><topic>Osteoporosis - epidemiology</topic><topic>Osteoporosis - etiology</topic><topic>Parathyroid</topic><topic>Parathyroid Hormone</topic><topic>Rheumatology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surveillance</topic><topic>Survival</topic><topic>Vitamin D</topic><topic>Vitamin deficiency</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Oh, H.J.</creatorcontrib><creatorcontrib>Yoon, B.-H.</creatorcontrib><creatorcontrib>Ha, Y.-C.</creatorcontrib><creatorcontrib>Suh, D.-C.</creatorcontrib><creatorcontrib>Lee, S.-M.</creatorcontrib><creatorcontrib>Koo, K.-H.</creatorcontrib><creatorcontrib>Lee, Y.-K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Osteoporosis international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Oh, H.J.</au><au>Yoon, B.-H.</au><au>Ha, Y.-C.</au><au>Suh, D.-C.</au><au>Lee, S.-M.</au><au>Koo, K.-H.</au><au>Lee, Y.-K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis</atitle><jtitle>Osteoporosis international</jtitle><stitle>Osteoporos Int</stitle><addtitle>Osteoporos Int</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>31</volume><issue>2</issue><spage>267</spage><epage>275</epage><pages>267-275</pages><issn>0937-941X</issn><eissn>1433-2965</eissn><abstract>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.</abstract><cop>London</cop><pub>Springer London</pub><pmid>31776636</pmid><doi>10.1007/s00198-019-05220-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-6564-4294</orcidid><orcidid>https://orcid.org/0000-0001-9373-9135</orcidid></addata></record> |
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| ispartof | Osteoporosis international, 2020-02, Vol.31 (2), p.267-275 |
| issn | 0937-941X 1433-2965 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Bone cancer Bone Density Bone loss Bone mineral density Bone resorption Bone turnover Calcium Endocrinology Female Gastrectomy Gastrectomy - adverse effects Gastric cancer Health surveillance Humans Hyperparathyroidism Long bone Malabsorption Male Medicine Medicine & Public Health Meta-analysis Metabolism Nutrient deficiency Original Article Orthopedics Osteoporosis Osteoporosis - epidemiology Osteoporosis - etiology Parathyroid Parathyroid Hormone Rheumatology Stomach Neoplasms - surgery Surveillance Survival Vitamin D Vitamin deficiency |
| title | The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis |
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