CALCIUM METABOLISM AND THE BONES AFTER PARTIAL GASTRECTOMY. I. CLINICAL FEATURES AND RADIOLOGY OF THE BONES.

Abstract

SUMMARYThe incidence of skeletal rarefaction was investigated in 100 control subjects and in 100 patients studied two to 15 years after partial gastrectomy. The two groups were comparable in age, sex and social class. Skeletal rarefaction was assessed subjectively by visual inspection of the X‐ray films and objectively by the measurement on the X‐ray films of the degree of wedging of the dorsal part of the spine, the degree of biconcavity of the lumbar part of the spine, and the cortical bone thickness of the shaft of the femur and the metacarpal.Rarefaction of the bones was twice as frequent in the gastrectomy group as in the control group. Furthermore, the skeletal abnormality was more severe in the patients after partial gastrectomy, as evidenced by the number of crush fractures of the vertebræ, the history of fractured bones following minimal trauma, and the presence of pain in the bones.Radiological evidence of bone rarefaction was more frequent in women than men in both the control group and the gastrectomy group. However, this difference of frequency in the sexes became less obvious in the post‐gastrectomy group, in which the percentage of men showing rarefaction more closely approached the percentage in women.Changes in the bones became increasingly frequent with advancing age in both of the groups that were investigated. Even so, bone disease was present at an earlier age in the patients after partial gastrectomy than in the control subjects.The incidence of skeletal rarefaction increased with the interval of time after partial gastrectomy, although there was no correlation between the age of the patient and the length of time after operation.Loss of weight, anæmia, the “dumping” syndrome and diarrhœa were more frequent in the patients with skeletal changes after gastrectomy than in the patients with normal bones.Judged by clinical criteria, 11 patients after partial gastrectomy appeared to have spinal osteoporosis and 18 patients had a syndrome resembling osteomalacia. Males predominated in the group with the condition resembling spinal osteoporosis, whereas the majority of patients with clinical features of osteomalacia were women. There was a long latent interval between operation and the development of skeletal symptoms. Eight patients had crush fractures of the spine and one patient had rib fractures and Looser's zones in the fibulæ. The high incidence of psychological disturbance, anæmia and undernutrition made evaluation of the skeletal symptoms difficult.