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Osteoporosis International

Erschienen in:

01.03.2015 | Original Article

Calcium gluconate supplementation is effective to balance calcium homeostasis in patients with gastrectomy

verfasst von: M. Krause, J. Keller, B. Beil, I. van Driel, J. Zustin, F. Barvencik, T. Schinke, M. Amling

Erschienen in: Osteoporosis International | Ausgabe 3/2015

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Abstract

Summary

We demonstrate histological evidence for hyperparathyroidism in patients with gastrectomy. This is, at least in part, explained by impaired calcium absorption, resulting in mineralization defects and secondary hyperparathyroidism. Additionally, we demonstrate improved bone mineralization in patients with gastrectomy after gluconate therapy and showed the effectiveness of calcium gluconate over carbonate to balance impaired calcium hemostasis in mice.

Introduction

Gastrectomy and hypochlorhydria due to long-term proton pump inhibitor therapy are associated with increased fracture risk because of intestinal calcium malabsorption. Hence, our objectives were to histologically investigate bone metabolism in patients with gastrectomy and to analyze the impact of calcium gluconate supplementation on skeletal integrity in the setting of impaired gastric acidification.

Methods

Undecalcified bone biopsies of 26 gastrectomized individuals were histologically analyzed. In the clinical setting, we retrospectively identified 5 gastrectomized patients with sufficient vitamin D level, who were additionally supplemented with calcium gluconate and had a real bone mineral density (aBMD) follow-up assessments. A mouse model of achlorhydria (ATP4b−/−) was used to compare the effect of calcium gluconate and calcium carbonate supplementation on bone metabolism.

Results

Biopsies from gastrectomized individuals showed significantly increased osteoid, osteoclast, and osteoblast indices and fibroosteoclasia (p < 0.05) as well as impaired calcium distribution in mineralized bone matrix compared to healthy controls. Five gastrectomized patients with sufficient vitamin D level demonstrated a significant increase in aBMD after a treatment with calcium gluconate alone for at least 6 months (p < 0.05). Calcium gluconate was superior to calcium carbonate in maintaining calcium metabolism in a mouse model of achlorhydria.

Conclusion

Gastrectomy is associated with severe osteomalacia, marrow fibrosis, and impaired calcium distribution within the mineralized matrix. We show that calcium gluconate supplementation can increase bone mineral density in gastrectomized individuals and performs superior to calcium carbonate in restoring calcium/skeletal homoeostasis in a mouse model of achlorhydria.

Nur mit Berechtigung zugänglich

Zaidi M (2007) Skeletal remodeling in health and disease. Nat Med 13(7):791–801. doi:10.1038/nm1593 CrossRefPubMed

Keller J, Schinke T (2013) The role of the gastrointestinal tract in calcium homeostasis and bone remodeling. Osteop Int J Estab Res COOPERATION Between EUROPEAN FOUNDATION Osteop National Osteop Found USA 24(11):2737–2748. doi:10.1007/s00198-013-2335-4 CrossRef

Howgate DJ, Graham SM, Leonidou A, Korres N, Tsiridis E, Tsapakis E (2013) Bone metabolism in anorexia nervosa: molecular pathways and current treatment modalities. Osteop Int J Estab Res COOPERATION Between EUROPEAN FOUNDATION Osteop National Osteop Found USA 24(2):407–421. doi:10.1007/s00198-012-2095-6 CrossRef

Ghishan FK, Kiela PR (2011) Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases. Am J Physiol Gastrointestin Liver Physiol 300(2):G191–G201. doi:10.1152/ajpgi.00496.2010 CrossRef

Lim JS, Kim SB, Bang HY, Cheon GJ, Lee JI (2007) High prevalence of osteoporosis in patients with gastric adenocarcinoma following gastrectomy. World J Gastroenterol WJG 13(48):6492–6497CrossRef

Mellstrom D, Johansson C, Johnell O, Lindstedt G, Lundberg PA, Obrant K, Schoon IM, Toss G, Ytterberg BO (1993) Osteoporosis, metabolic aberrations, and increased risk for vertebral fractures after partial gastrectomy. Calcif Tissue Int 53(6):370–377PubMed

Paakkonen M, Alhava EM, Karjalainen P, Korhonen R, Savolainen K, Syrjanen K (1984) Long-term follow-up after Billroth I and II partial gastrectomy. Gastrointestinal tract function and changes in bone metabolism. Acta Chir Scand 150(6):485–488PubMed

Straub DA (2007) Calcium supplementation in clinical practice: a review of forms, doses, and indications. Nutri Clin Pract Off Public Am Soc Parent Enteral Nutri 22(3):286–296CrossRef

Schinke T, Schilling AF, Baranowsky A, Seitz S, Marshall RP, Linn T, Blaeker M, Huebner AK, Schulz A, Simon R, Gebauer M, Priemel M, Kornak U, Perkovic S, Barvencik F, Beil FT, Del Fattore A, Frattini A, Streichert T, Pueschel K, Villa A, Debatin KM, Rueger JM, Teti A, Zustin J, Sauter G, Amling M (2009) Impaired gastric acidification negatively affects calcium homeostasis and bone mass. Nat Med 15(6):674–681. doi:10.1038/nm.1963 CrossRefPubMed

10.

Yang YX, Lewis JD, Epstein S, Metz DC (2006) Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA J Am Med Assoc 296(24):2947–2953. doi:10.1001/jama.296.24.2947 CrossRef

11.

Aoki K, Kihaile PE, Wenyuan Z, Xianghang Z, Castro M, Disla M, Nyambo TB, Misumi J (2005) Comparison of prevalence of chronic atrophic gastritis in Japan, China, Tanzania, and the Dominican Republic. Ann Epidemiol 15(8):598–606. doi:10.1016/j.annepidem.2004.11.002 CrossRefPubMed

12.

Ihamaki T, Sipponen P, Varis K, Kekki M, Siurala M (1991) Characteristics of gastric mucosa which precede occurrence of gastric malignancy: results of long-term follow-up of three family samples. Scandi J Gastroenterol Suppl 186:16–23CrossRef

13.

Breer S, Krause M, Busse B, Hahn M, Ruther W, Morlock MM, Amling M, Zustin J (2012) Analysis of retrieved hip resurfacing arthroplasties reveals the interrelationship between interface hyperosteoidosis and demineralization of viable bone trabeculae. J Orthop Res Off Public Orthop Res Soc 30(7):1155–1161. doi:10.1002/jor.22035 CrossRef

14.

Dempster DW, Compston JE, Drezner MK, Glorieux FH, Kanis JA, Malluche H, Meunier PJ, Ott SM, Recker RR, Parfitt AM (2013) Standardized nomenclature, symbols, and units for bone histomorphometry: a 2012 update of the report of the ASBMR histomorphometry nomenclature committee. J Bone Min Res Off J Am Soc Bone Min Res 28(1):2–17. doi:10.1002/jbmr.1805 CrossRef

15.

Krause M, Soltau M, Zimmermann EA, Hahn M, Kornet J, Hapfelmeier A, Breer S, Morlock M, Wulff B, Puschel K, Glueer CC, Amling M, Busse B (2014) Effects of long-term alendronate treatment on bone mineralisation, resorption parameters and biomechanics of single human vertebral trabeculae. Euro Cells Mat 28:152–165

16.

Roschger P, Paschalis EP, Fratzl P, Klaushofer K (2008) Bone mineralization density distribution in health and disease. Bone 42(3):456–466. doi:10.1016/j.bone.2007.10.021 CrossRefPubMed

17.

Krause M, Museyko O, Breer S, Wulff B, Duckstein C, Vettorazzi E, Glueer C, Puschel K, Engelke K, Amling M (2014) Accuracy of trabecular structure by HR-pQCT compared to gold standard muCT in the radius and tibia of patients with osteoporosis and long-term bisphosphonate therapy. Osteop Int J Estab Res COOPERATION Between EUROPEAN FOUNDATION Osteop National Osteop Found USA 25(5):1595–1606. doi:10.1007/s00198-014-2650-4 CrossRef

18.

Scarff KL, Judd LM, Toh BH, Gleeson PA, Van Driel IR (1999) Gastric H(+), K(+)-adenosine triphosphatase beta subunit is required for normal function, development, and membrane structure of mouse parietal cells. Gastroenterology 117(3):605–618CrossRefPubMed

19.

Cunningham J, Locatelli F, Rodriguez M (2011) Secondary hyperparathyroidism: pathogenesis, disease progression, and therapeutic options. Clinic J Am Soc Nephrol CJASN 6(4):913–921. doi:10.2215/CJN.06040710 CrossRef

20.

Krause M, Anschutz W, Vettorazzi E, Breer S, Amling M, Barvencik F (2014) Vitamin D deficiency intensifies deterioration of risk factors, such as male sex and absence of vision, leading to increased postural body sway. Gait Post 39(1):166–171. doi:10.1016/j.gaitpost.2013.06.017 CrossRef

21.

Recker RR (1985) Calcium absorption and achlorhydria. N Engl J Med 313(2):70–73. doi:10.1056/NEJM198507113130202 CrossRefPubMed

22.

Heller HJ, Stewart A, Haynes S, Pak CY (1999) Pharmacokinetics of calcium absorption from two commercial calcium supplements. J Clin Pharmacol 39(11):1151–1154PubMed

23.

Baek KH, Jeon HM, Lee SS, Lim DJ, Oh KW, Lee WY, Rhee EJ, Han JH, Cha BY, Lee KW, Son HY, Kang SK, Kang MI (2008) Short-term changes in bone and mineral metabolism following gastrectomy in gastric cancer patients. Bone 42(1):61–67. doi:10.1016/j.bone.2007.08.027 CrossRefPubMed

24.

Bisballe S, Eriksen EF, Melsen F, Mosekilde L, Sorensen OH, Hessov I (1991) Osteopenia and osteomalacia after gastrectomy: interrelations between biochemical markers of bone remodelling, vitamin D metabolites, and bone histomorphometry. Gut 32(11):1303–1307CrossRefPubMedCentralPubMed

25.

Rumenapf G, Schwille PO, Erben RG, Schreiber M, Fries W, Schmiedl A, Hohenberger W (1997) Osteopenia following total gastrectomy in the rat—state of mineral metabolism and bone histomorphometry. Euro Surg Res Europaische Chirurgische Forschung Recherches Chirurgicales Euro 29(3):209–221CrossRef

26.

Adachi Y, Shiota E, Matsumata T, Iso Y, Yoh R, Kitano S (2000) Osteoporosis after gastrectomy: bone mineral density of lumbar spine assessed by dual-energy X-ray absorptiometry. Calcif Tissue Int 66(2):119–122CrossRefPubMed

27.

Fleischer J, Stein EM, Bessler M, Della Badia M, Restuccia N, Olivero-Rivera L, McMahon DJ, Silverberg SJ (2008) The decline in hip bone density after gastric bypass surgery is associated with extent of weight loss. J Clin Endocrinol Metab 93(10):3735–3740. doi:10.1210/jc.2008-0481 CrossRefPubMedCentralPubMed

28.

Heiskanen JT, Kroger H, Paakkonen M, Parviainen MT, Lamberg-Allardt C, Alhava E (2001) Bone mineral metabolism after total gastrectomy. Bone 28(1):123–127CrossRefPubMed

29.

Schmiedl A, Schwille PO, Stuhler C, Gohl J, Rumenapf G (1999) Low bone mineral density after total gastrectomy in males: a preliminary report emphasizing the possible significance of urinary net acid excretion, serum gastrin and phosphorus. Clin Chem Lab Med CCLM / FESCC 37(7):739–744. doi:10.1515/CCLM.1999.114 CrossRef

30.

Thompson GR, Lewis B, Booth CC (1966) Vitamin-D absorption after partial gastrectomy. Lancet 1(7435):457–458CrossRefPubMed

31.

Thomson AB, Sauve MD, Kassam N, Kamitakahara H (2010) Safety of the long-term use of proton pump inhibitors. World J Gastroenterol WJG 16(19):2323–2330CrossRef

32.

Corley DA, Kubo A, Zhao W, Quesenberry C (2010) Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 139(1):93–101. doi:10.1053/j.gastro.2010.03.055 CrossRefPubMedCentralPubMed

33.

Vestergaard P, Rejnmark L, Mosekilde L (2006) Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int 79(2):76–83. doi:10.1007/s00223-006-0021-7 CrossRefPubMed

34.

Yu EW, Bauer SR, Bain PA, Bauer DC (2011) Proton pump inhibitors and risk of fractures: a meta-analysis of 11 international studies. Am J Med 124(6):519–526. doi:10.1016/j.amjmed.2011.01.007 CrossRefPubMedCentralPubMed

35.

Mattsson JP, Vaananen K, Wallmark B, Lorentzon P (1991) Omeprazole and bafilomycin, two proton pump inhibitors: differentiation of their effects on gastric, kidney and bone H(+)-translocating ATPases. Biochim Biophys Acta 1065(2):261–268CrossRefPubMed

36.

Tuukkanen J, Vaananen HK (1986) Omeprazole, a specific inhibitor of H+-K+-ATPase, inhibits bone resorption in vitro. Calcif Tissue Int 38(2):123–125CrossRefPubMed

37.

O’Connell MB, Madden DM, Murray AM, Heaney RP, Kerzner LJ (2005) Effects of proton pump inhibitors on calcium carbonate absorption in women: a randomized crossover trial. Am J Med 118(7):778–781. doi:10.1016/j.amjmed.2005.02.007 CrossRefPubMed

Titel: Calcium gluconate supplementation is effective to balance calcium homeostasis in patients with gastrectomy
verfasst von: M. Krause
J. Keller
B. Beil
I. van Driel
J. Zustin
F. Barvencik
T. Schinke
M. Amling
Publikationsdatum: 01.03.2015
Verlag: Springer London
Erschienen in: Osteoporosis International / Ausgabe 3/2015
Print ISSN: 0937-941X
Elektronische ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-014-2965-1

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Calcium gluconate supplementation is effective to balance calcium homeostasis in patients with gastrectomy

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