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Risk factors for loss of bone mineral density after curative esophagectomy

Artikel i vetenskaplig tidskrift
Författare J. A. Elliott
S. Casey
C. F. Murphy
Neil G. Docherty
N. Ravi
P. Beddy
J. V. Reynolds
Carel W le Roux
Publicerad i Archives of Osteoporosis
Volym 14
Nummer/häfte 1
ISSN 1862-3522
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för gastrokirurgisk forskning och utbildning
Språk en
Länkar dx.doi.org/10.1007/s11657-018-0556-...
Ämnesord Bone, Bone mineral density, Esophagectomy, Esophageal cancer, Malnutrition, Malabsorption, gastric bypass-surgery, proton pump inhibitors, quality-of-life, calcium-absorption, post-esophagectomy, metabolism, malnutrition, gastrectomy, acidity, chemoradiotherapy, Endocrinology & Metabolism, Orthopedics, holic j, 1993, digestion, v54, p73
Ämneskategorier Ortopedi, Invärtesmedicin

Sammanfattning

.Summary Micronutrient and fat malabsorption and altered enteroendocrine signaling occur after esophagectomy for cancer; however, the impact of malnutrition on bone health in this cohort has not been previously investigated. In this study, the prevalence of osteoporosis increased after curative surgery, associated with disease-specific, treatment-related, and population risk factors.PurposeImproved oncologic outcomes in esophageal cancer (EC) have resulted in increased survivorship and a focus on long-term quality of life. Malnutrition and micronutrient malabsorption are common among patients with EC, but the effect on bone metabolism is not known. The aim of this study was to characterize changes in bone mineral density (BMD) following curative esophagectomy.MethodsConsecutive disease-free patients who underwent esophagectomy with gastric conduit for pathologically node-negative disease from 2000 to 2014 were included. BMD was assessed at vertebral levels T12-L5 by computed tomography using a simple trabecular region-of-interest attenuation technique, and serum markers of nutritional status and bone metabolism were examined. Independent risk factors for osteoporosis were identified by multivariable logistic regression.ResultsSeventy-five consecutive patients were studied. Osteoporosis was present in 25% at diagnosis. BMD declined at 1 and 2years postoperatively (144.345.8 versus 128.6 +/- 46.2 and 122.7 +/- 43.5 Hounsfield Units (HU), P<0.0001), with increased osteoporosis prevalence to 38% and 44% (P=0.049), respectively. No significant postoperative change in vitamin D, calcium, or phosphate was observed, but alkaline phosphatase increased significantly (P<0.001). While female sex (P=0.004) and ASA grade (P=0.043) were independently associated with osteoporosis at diagnosis, age (P=0.050), female sex (P=0.023), smoking (P=0.024), and pathologic T stage (P=0.023) were independently predictive of osteoporosis at 1year postoperatively.Conclusions p id=Par5 Osteoporosis is prevalent among disease-free patients post-esophagectomy for EC, associated with disease-specific, treatment-related, and population risk factors. Strategies which minimize BMD decline should be considered to avoid fragility fractures in this cohort.

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