Increased Risk for Osteoporotic Fractures in Elderly After Gastrectomy

Fracture risk remained higher decades after surgery in men who underwent gastrectomy compared with patients who never underwent the procedure.

Elderly patients who have undergone gastrectomy are at higher risk for fracture compared with patients without a history of gastrectomy, according to study results published in Bone. In addition, the risk for fractures remained higher in these patients decades after surgery.

As limited data are available regarding the association between gastrectomy and osteoporotic fractures, the goal of this study was to explore the association between gastrectomy and bone mineral density (BMD), bone metabolism markers, and long-term fracture risk in older men.

The study enrolled 1985 community-dwelling elderly Japanese men aged ≥65 years at enrollment with available BMD values at the spine and hip. Researchers measured serum levels of parathyroid hormone, intact osteocalcin, tartrate-resistant acid phosphatase isoenzyme 5b, and undercarboxylated osteocalcin. Trained nurses collected data regarding fracture history and gastrectomy from interviews conducted during the follow-up surveys.

Of the 1985 patients analyzed, 132 had gastrectomy for gastric cancer or gastric or duodenal ulcer. Men who had undergone gastrectomy had higher levels of bone metabolism markers and lower areal BMD at baseline, in addition to greater areal BMD reduction during the follow-up period, compared with patients without a history of gastrectomy.

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During median follow-up of 4.5 years, there were 44 osteoporotic fractures (5.1 fractures per 1000 person-years), with major osteoporotic fractures recorded in 31 men (3.6 per 1000 person-years). The incidence rate of osteoporotic fracture was significantly higher in patients with a history of gastrectomy (13.9 per 1000 person-years) compared with patients who did not undergo gastrectomy (4.5 per 1000 person-years).

The adjusted risk for osteoporotic fracture was significantly higher in those who had undergone gastrectomy, but after further adjustment for parathyroid hormone level and areal BMD, the difference was no longer significant. However, in a model incorporating years since gastrectomy, the investigators found a significantly higher risk for osteoporotic fracture with ≥20 years since gastrectomy (hazard ratio, 3.56; 95% CI 1.33-9.52).

The investigators acknowledged several study limitations, including small sample size and possible healthy user bias, which may have led to an underestimation of the association between gastrectomy and osteoporotic fractures. In addition, much of the data collected were based on interviews, there were missing data regarding the type of surgical resection and reconstruction methods, and the outcomes were based on self-reported data.

“Gastrectomized men should be observed long-term for the management of osteoporosis and [osteoporotic fracture] risk,” concluded the researchers.

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Iki M, Fujita Y, Kouda K, et al. Increased risk of osteoporotic fracture in community-dwelling elderly men 20 or more years after gastrectomy: the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) cohort study. Bone. 2019;127:250-259.