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Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion

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Abstract

Secondary hyperparathyroidism (SH) is a frequent metabolic complication of bariatric surgery. Around 70% of patients who undergo biliopancreatic diversion (BPD) have this complication in the long term. The aim of this study was to evaluate the relative influence of vitamin D deficiency and calcium malabsorption in the development of SH in patients who underwent BPD. We reviewed the mean values of PTH throughout the post-operative follow-up and of related biochemical data (25-hydroxyvitamin D, calcium, magnesium) of 121 patients who underwent BPD at our institute from November 1996 to November 2004 (mean follow-up 66 months). MeanPTH correlated negatively with mean 25-hydroxyvitamin D (r=−0.27, p=0.003) and with urinary calcium (r=−0.19, p=0.047), and positively with age (r=0.22, p=0.018). However, a high mean PTH was found in 48.7% patients with mean 25-hydroxyvitamin D ≥30 ng/ml and in 80.0% patients with mean 25-hydroxyvitamin D between 20 and 30 ng/ml. The mean PTH was normal in 5 patients without calcium supplements at present, and progressively increased in parallel to the calcium dose in the rest of patients, although mean 25-hydroxyvitamin D levels were not related to the calcium dose. Our data suggest that individual differences in active and/or passive calcium absorption determine intractable SH after BPD in around half of the patients who have normal levels of 25-hydroxyvitamin D and in 80% of patients with 25-hydroxyvitamin D levels between 20 and 30 ng/ml after BPD, worsening with age.

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Authors and Affiliations

  1. Department of Endocrinology and Clinical Nutrition, Ramón y Cajal Hospital, Carretera de Colmenar Km. 9.1, 28034, Madrid, Spain

    J. A. Balsa MD, PhD, J. I. Botella-Carretero, I. Zamarrón, F. Arrieta & C. Vázquez

  2. Department of Surgery, Ramón y Cajal Hospital, Madrid, Spain

    R. Peromingo

  3. Departemnt of Biochemistry, Ramón y Cajal Hospital, Madrid, Spain

    T. Muñoz-Malo

Authors
  1. J. A. Balsa MD, PhD
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  2. J. I. Botella-Carretero
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  3. R. Peromingo
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  4. I. Zamarrón
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  5. F. Arrieta
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  6. T. Muñoz-Malo
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  7. C. Vázquez
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Correspondence to J. A. Balsa MD, PhD.

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Balsa, J.A., Botella-Carretero, J.I., Peromingo, R. et al. Role of calcium malabsorption in the development of secondary hyperparathyroidism after biliopancreatic diversion. J Endocrinol Invest 31, 845–850 (2008). https://doi.org/10.1007/BF03346429

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  • DOI: https://doi.org/10.1007/BF03346429

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