Introduction
Gastrectomy for gastric cancer causes long term complications. However, cancer treatment-induced bone loss remains unclear1. We have previously evaluated osteoporosis in several disease by using Dual-energy X-ray Absorptiometry(DXA) and high-resolution peripheral quantitative computed tomography (HR-pQCT)2-4.
Aims & Methods
The aim of this study was to evaluate osteoporosis by using DXA and HR-pQCT more than 5 years after gastrectomy.
This observational study included 42 male patients (21 distal gastrectomy (DG), 21 total gastrectomy (TG)) more than 5 years after gastrectomy due to gastric cancer (GC group) and age-matched 63 male healthy volunteer donors (control group). We excluded women to avoid the effects of menopause.
In osteoporosis markers, such as 25-OH Vitamin D (25OHVD), tartrate-resistant acid phosphatase-5b (TRACP-5b), and procollagen type-I N-terminal propeptide (Total P1NP), were measured in both groups
Areal bone mineral density (aBMD) of the lumbar spine and proximal femur were analyzed by DXA.
Total, cortical, and trabecular volumetric bone mineral density (Tt.vBMD, Ct.vBMD, and Tb.vBMD) of the radius and distal tibia were analyzed by HR-pQCT. Cortical and trabecular thickness (Ct.Th and Tb.Th) of the radius and distal tibia were analyzed by HR-pQCT.
The primary endpoint was the difference of bone mineral density, bone microstructure and bone metabolism markers between the control and the GC groups.
The secondary endpoint was the difference of bone mineral density, bone microstructure and bone metabolism markers between the DG and TG groups.
Results
1. Gastrectomy on bone mineral density and microstructure
In DXA, lumbar and femoral aBMD were significantly lower in the GC group (control vs GC; 1.24 ± 0.23 vs 1.08 ± 0.30, P < 0.01, control vs GC; 0.88 ± 0.13 vs 0.78 ± 0.15, P < 0.01, respectively).
In HR-pQCT, Tt.vBMD of the radius and tibia was also significantly lower in the GC group. Radial and tibial Ct.vBMD were significantly lower in the GC group .Radial and tibial Ct.Th were significantly lower in the GC group.
| Radius | Control | GC | P value |
| Tibia | Control | GC | P value |
| Tot.vBMD | 271.5 ± 58.5 | 240.8 ± 70.7 | P = 0.02 |
| Tot.vBMD | 276.9 ± 46.4 | 243.4± 70.7 | P = 0.02 |
| Tb.vBMD | 145.1 ± 34.4 | 130.1 ± 41.8 | P < 0.05 |
| Tb.vBMD | 159.4 ± 31.2 | 146.4 ± 39.5 | n.s. |
| Ct. vBMD | 847.3 ± 57.5 | 811.0 ± 83.9 | P < 0.01 |
| Ct. vBMD | 852.5 ± 52.4 | 798.3 ± 72.4 | P < 0.01 |
| Tb.Th | 0.24 ± 0.02 | 0.23 ± 0.02 | n.s. |
| Tb.Th | 0.26 ± 0.02 | 0.25 ± 0.02 | n.s. |
| Ct.Th | 1.01 ± 0.21 | 0.90 ± 0.24 | P = 0.02 |
| Ct.Th | 1.49 ± 0.26 | 1.30 ± 0.33 | P < 0.01 |
The serum intact PTH, TRACP-5b, and Total P1NP levels in the GC group were significantly higher than in control group (control vs GC; med 44.6 vs 55.3, P < 0.01, control vs GC; med 325 vs 474.5, P < 0.01, and control vs GC; med 40.6 vs 46.9, P < 0.01, respectively). The serum 25OHVD and albumin level in the GC group were significantly lower than in control group (control vs GC; med 20.2 vs 16.3, P = 0.05, control vs GC; 4.3 vs 4.1, P < 0.01, respectively).
2. Total and distal gastrectomy on bone mineral density and microstructure
In DXA, lumbar and femoral aBMD was significantly lower in the TG group (DG vs TG; 1.17 ± 0.28 vs 1.00 ± 0.30, P < 0.01, DG vs TG; 0.83 ± 0.13 vs 0.73 ± 0.15, P < 0.01, respectively). In HR-pQCT, radial and tibial Ct.vBMD were significantly lower in the GC group (DG vs TG; 834.1 ± 71.6mg/cm3 vs 787.8 ± 90.5mg/cm3, P = 0.03, DG vs TG; 811.4 ± 72.1mg/cm3 vs 785.3 ± 72.0 mg/cm3, P < 0.01, respectively). There were no differences in osteoporosis markers between the DG and TG groups.
Conclusion
Osteoporosis after gastrectomy was more progressive than healthy volunteers over a long period. Bone deterioration after total gastrectomy was more progressive in the cortical bone than distal gastrectomy.
References
1: Atsumi Y, Rino Y, Wada H, et al. Changes in bone metabolism after gastric cancer surgery in male patients: a prospective observational study. Gastric Cancer. 2019
2: Shiraishi K, Chiba K, Okazaki N et al. In vivo analysis of subchondral trabecular bone in patients with osteoarthritis of the knee using second-generation high-resolution peripheral quantitative computed tomography (HR-pQCT). Bone. 2020
3: Kuba S, Watanabe K, Chiba K et al. Adjuvant endocrine therapy effects on bone mineral density and microstructure in women with breast cancer. J Bone Miner Metab. 2021
4: Doi M, Chiba K, Okazaki N et al. Bone microstructure in healthy men measured by HR-pQCT: Age-related changes and their relationships with DXA parameters and biochemical markers. Bone. 2022
Disclosure
There was no disclosure.