Impact of gastrectomy for gastric cancer on postoperative bone mineral density loss and fracture risk: A multicenter study

Abstract

Background: Bone mineral density (BMD) reduction and vertebral fractures (VFs) are complications following gastrectomy for gastric cancer (GC), impacting both quality of life and mortality. However, the longitudinal effects of gastrectomy on BMD and VFs remain unclear.

Methods: This multicenter retrospective study analyzed 485 patients with GC who underwent curative gastrectomy between 2005 and 2018. The patients were categorized by gastrectomy (distal gastrectomy [DG] or total gastrectomy [TG]) and reconstruction (Billroth-I [BI] or Roux-en-Y [RY]). BMD was assessed using L1 vertebral computed tomography attenuation, and VFs were evaluated preoperatively and 1, 3, and 5 years postoperatively. Statistical analyses identified predictive factors for BMD reduction and VFs.

Results: The TGRY group showed the greatest BMD reduction, followed by the DGRY and DGBI groups, over the 5-year period. Patients who underwent TGRY had a significantly greater decrease in BMD than those who underwent DGRY (coefficient: 10.02, 95 % confidence interval [CI]: 5.53-14.50, P < 0.001), while patients who underwent DGBI experienced a significantly smaller decrease (coefficient: -5.55, 95 % CI: -9.52 to -1.55, P = 0.007). The overall incidence of VFs at 5 years was 19.2 %, with a significantly greater BMD reduction observed in the VF group. The type of gastrectomy and reconstruction method were not significant risk factors for VFs.

Conclusions: BMD reduction was better contained in DGRY than TGRY and in DGBI than DGRY. While VFs were more frequent in TGRY, these differences were not statistically significant. However, significant BMD reduction was observed in patients with VFs, suggesting a potential correlation.

Keywords: Bone diseases; Gastrectomy; Gastric cancer; Metabolic.