Osteomalacia with Bone Marrow Fibrosis Due to Severe Vitamin D Deficiency After a Gastrointestinal Bypass Operation for Severe Obesity |
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| Institution: | 1. Turku PET Centre, University of Turku, Turku, Finland;2. Department of Radiology, Turku University, Medical Imaging Centre of Southwest Finland and Turku University Hospital, Helsinki, Finland;3. Children''s Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland;4. HUS Medical Imaging Center, Radiology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland;5. Novo Nordisk Farma Oy, Espoo, Finland;6. Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University, Düsseldorf, Germany;7. German Center for Diabetes Research, Partner Düsseldorf, Düsseldorf, Germany;8. Folkhälsan Institute of Genetics, Helsinki, Finland;9. Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden;10. Department of Molecular Medicine and Surgery, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden;1. Department of Population Health Sciences and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029;2. Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF), San Francisco, California 94107;3. Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York 10029;4. Department of Radiology, Mayo Clinic, Rochester, Minnesota 55902;5. Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201-1595;1. Department of Oncology at San Luigi Hospital, University of Turin, Orbassano, Turin 10043, Italy;2. Division of Pathology at San Luigi Hospital, Orbassano, Orbassano, Turin 10043, Italy;3. Division of Pathology, Città della Salute Hospital, Turin 10126, Italy;4. Division of Urology, Città della Salute Hospital, Turin 10126, Italy;5. Division of Medical Oncology at San Luigi Hospital, Orbassano, Turin 10043, Italy;6. Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia 25121, Italy |
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| Abstract: | ObjectiveTo present 5 cases of bone biopsy-proven osteomalacia with marrow fibrosis (in 3 cases) after gastric bypass operation, review the relevant literature, and offer preventive strategies.MethodsWe summarize the clinical presentation, pertinent biochemical and radiologic data, and bone histomorphometric findings in 5 patients, encountered during a period of 17 years, in whom severe vitamin D deficiency developed after a gastrointestinal bypass surgical procedure for morbid obesity.ResultsFive patients (39 to 60 years of age) were seen for evaluation of metabolic bone disease not responding to “usual” therapy after a gastric bypass surgical procedure. All had generalized bone pain and tenderness, muscle weakness, stooping posture, difficulty walking, and waddling gait due to severe proximal muscle weakness for a period of 2 to 5 years. Diagnoses before the referral varied from arthritis and gout to vitamin D deficiency and osteoporosis despite highly suggestive biochemical or radiologic findings (or both) of osteomalacia in each patient, which was confirmed by bone biopsy. After therapy with pharmacologic doses of ergocalciferol (100,000 IU daily) and calcium carbonate (1 to 2.5 g daily), considerable improvements occurred in clinical symptoms and functional status, biochemical indices, bone mineral density, and bone histomorphometric features.ConclusionGastric bypass operations predispose patients to severe vitamin D deficiency and osteomalacia in the absence of pharmacologic doses of vitamin D therapy. In general, the current recommendations are grossly inadequate in this high-risk population, and the clinical presentation is both nonspecific and often misleading. Prospective long-term studies are needed to determine the appropriate vitamin D dose required to prevent osteomalacia in such patients. (Endocr Pract. 2009;15:528-533) |
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