Gastrectomy/
gastric bypass has been used for patients with
gastric cancer, and its application is now expanding to treating patients with
morbid obesity, the prevalence of which is increasing worldwide. It is well known that
gastrectomy leads to
osteopenia, but the underlying pathophysiology and optimum treatments for this disorder have not been delineated. We followed 13 patients who showed progressive
osteopenia (bone mineral density T-score<-2.4 SD) after
gastrectomy/
gastric bypass due to
gastric cancer and who were resistant to long-term treatment (mean, 6 years) of active
vitamin D3 and prospectively studied the effects of
alendronate, a
bisphosphonate, on
osteopenia-related parameters for 2 years.
Oral administration of
alendronate in addition to
vitamin D3 led to remarkable improvement within 2 years, not only in clinical symptoms, such as radial
bone fractures and lumbar
pain, but also in parameters for
osteopenia, including decreased bone mineral density of the lumbar spine (P<0.01), decreased concentrations of
calcium (P<0.05), increased urine levels of
deoxypyridinoline (P<0.01), increased serum levels of bone-specific
alkaline phosphatase (P<0.01), increased serum levels of
osteocalcin (P<0.01), and increased serum levels of intact
parathyroid hormone (P<0.05), although
body weight did not alter. These results suggest that
bisphosphonate may improve
osteopenia after
gastrectomy/
gastric bypass.