Influence of surgical reconstruction after partial or total gastrectomy on the mineral metabolism

After gastrectomy, a considerable proportion of the patients develop postgastrectomy bone disease (PBD). One feature of PBD is a decreased bone mineral density, resulting in an increased fracture risk. Possibly, calcium soap formation or vitamin D deficiency due to fat malabsorption contributes to the changes in the calcium and bone metabolism observed. To evaluate the preservation of the duodenal passage for calcium and bone metabolism, we compared Billroth I with Billroth II gastrectomy patients, and Roux-Y reconstruction patients with Longmire reconstruction patients after total gastrectomy. However, no significant differences could be observed with regard to calcium or bone metabolism. Although the duodenum has the highest capacity of the small intestine for calcium absorption, preservation of the duodenal passage after gastrectomy does not prevent PBD, indicating that the incidence of PBD is independent of the reconstruction method used.