Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion
Abstract
Background Biliopancreatic diversion (BPD) is associated with a 70% excess weight loss (EWL) at 10 years, but there are concerns regarding long-term nutritional sequelae. Metabolic bone disease has been documented following Roux-en-Y gastric bypass.Methods Patients who underwent a BPD from 1998 to 2001 were studied. A questionnaire was designed to review BPD patients and collect information on weight loss, frequency of gastrointestinal disturbances and compliance with multivitamin recommendations. The review included a blood test for vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium.Results Of the 82 patients who underwent BPD during this period, the median %EWL at 36 months was 73.0%. 75.6% suffered diarrhea. At median follow-up of 32 months (18-50), 25.9% of patients were hypocalcemic, 50% had low vitamin D, 23.8% had elevated ALP, and 63.1% had elevated PTH, despite 82.9% taking multivitamins.Conclusion BPD results in significant weight loss. However, 1 in 4 patients are hypocalcemic, and 1 in 2 have a low vitamin D, despite multivitamin supplementation. BPD patients require routine calcium and vitamin D supplementation for life. Long-term sequelae from these abnormal serum levels are not known.
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After BPD/DS, more than 50% of patients have vitamin D deficiency and estimates of secondary hyperparathyroidism range from 60% to 100% even with aggressive supplementation.
“After BPD/DS more than 50% of patients have vitamin D deficiency and estimates of secondary hyperparathyroidism range from 60-100% even with aggressive supplementation75, 77-79.”
From Bone loss after bariatric surgery: causes, consequences, and management (2014) · cites this paper as [77]
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Ramos, M. A., Rodríguez, I. M. C., Fondo, A. M. U., de la Maza, B. P., Galindo, D. E. B., Martínez, P. F., González-Herráez, L., de Francisco, T. G., & Ballesteros-Pomar, M. D. (2018) · Obesity Surgery · doi:10.1007/s11695-018-03624-3 · Cited by 15 · see citing works
Improving vitamin D status in bariatric surgery subjects with monthly high-dose ergocalciferol
Galyean, S., Syn, D., Subih, H. S., & Boylan, M. L. (2021) · International Journal for Vitamin and Nutrition Research · doi:10.1024/0300-9831/a000728 · Cited by 26 · see citing works
Counteracting the Trajectory of Frailty and Sarcopenia in Older Adults
Litchford, M. D. (2014) · Nutrition in Clinical Practice · doi:10.1177/0884533614536231 · Cited by 15 · see citing works
Metabolic and nutritional changes after bariatric surgery
Salameh, B., Khoukaz, M., & Bell, R. L. (2010) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/egh.09.67 · Cited by 14 · see citing works
Andalib, A., Safar, A., Bouchard, P., Demyttenaere, S. V., & Court, O. (2023) · Obesity Surgery · doi:10.1007/s11695-023-06900-z · Cited by 13 · see citing works
Nutritional Support of the Obese and Critically Ill Obese Patient
Kaafarani, H. M. A., & Shikora, S. A. (2011) · Surgical Clinics of North America · doi:10.1016/j.suc.2011.04.009 · Cited by 13 · see citing works
Sundaram, U., McBride, C. L., Shostrom, V., Meza, J. L., & Goldner, W. S. (2013) · Bariatric Surgical Practice and Patient Care · doi:10.1089/bari.2013.0006 · Cited by 13 · see citing works
Bariatric Nutrition: Suggestions for the Surgical Weight Loss Patient
Aills, L., Blankenship, J. D., Buffington, C. K., Furtado, M. M., & Parrott, J. M. (2008) · Cited by 12 · see citing works
Entrenas, A. O., Tubio, D. L., Navarro, F. L., Carvajal, F. M., Adán, N. G., Redondo, M., & Osinaga, J. A. (2016) · Obesity Surgery · doi:10.1007/s11695-016-2519-z · Cited by 12 · see citing works
Palal, B., Sinsakul, M. V., & Reutrakul, S. (2011) · Case Reports in Endocrinology · doi:10.1155/2011/370583 · Cited by 11 · see citing works
Metabolic Bone Disease in Gastrointestinal Illness
Williams, S. E. I., & Seidner, D. L. (2007) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2007.01.005 · Cited by 11 · see citing works
Brancatella, A., Cappellani, D., Vignali, E., Canale, D., & Marcocci, C. (2017) · Journal of the Endocrine Society · doi:10.1210/js.2017-00114 · Cited by 10 · see citing works
Deficiências nutricionais após cirurgia bariátrica: por que ocorrem?
Bordalo, L. A., Mourão, D. M., & Bressan, J. (2025) · Acta Médica Portuguesa · doi:10.20344/amp.1564 · Cited by 10 · see citing works
Saliva with reduced calcium and phosphorous concentrations: Effect on erosion dental lesions
Denucci, G. C., Mantilla, T. F., Amaral, F., Basting, R. T., França, F., & Turssi, C. (2018) · Oral Diseases · doi:10.1111/odi.12843 · Cited by 10 · see citing works
Phosphocalcic Metabolism after Biliopancreatic Diversion
Lozano, O., García-Díaz, J. D. D., Cancer, E., Arribas, I., Rubio, J. L., González-García, I., Galván, M., Alvarez, J. C., & Martín‐Duce, A. (2007) · Obesity Surgery · doi:10.1007/s11695-007-9108-0 · Cited by 9 · see citing works
- Authors
- Newbury, L., Dolan, K., Hatzifotis, M., Low, N., & Fielding, G.
- Affiliations
- Royal Brisbane and Women's Hospital (AU)
- Venue
- Obesity Surgery
- Published
- 2003-12-01
- Volume
- 13
- Issue
- 6
- Pages
- 893-895
- ISSN
- 0960-8923 (ISSN-L)
- 1708-0428
- OpenAlex
- W2078290451
- Cited by
- 156
- References
- 10
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 6 · 2017: 6 · 2016: 4 · 2015: 8 · 2014: 8 · 2013: 3 · 2012: 9
- FWCI
- 9.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Obesity Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Body Contouring and Surgery
- Keywords
- biliopancreatic diversion, parathyroid hormone
- MeSH terms
- Alkaline Phosphatase, Anastomosis, Roux-en-Y, Bone Diseases, Metabolic, Calcium, Female, Gastrectomy, Humans, Hypocalcemia, Male, Middle Aged, Obesity, Morbid, Parathyroid Hormone, Vitamin D, Vitamin D Deficiency, Gastric Bypass, Biliopancreatic Diversion
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