The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis

  • H.J. Oh
  • B.-H. Yoon
  • Y.-C. Ha
  • D.-C. Suh
  • S.-M. LeeEmail author
  • K.-H. Koo
  • Y.-K. LeeEmail author
Original Article



Bone mineral density (BMD) is significantly decreased after gastrectomy in patients with gastric cancer. Calcium malabsorption, secondary hyperparathyroidism, and dominant bone resorption appear to contribute to bone loss in these patients. Patients should undergo early surveillance and nutritional or pharmacologic intensive interventions for bone health.


Survivorship care, including bone health, has become an important issue in gastric cancer. We performed a meta-analysis of the available observational studies to determine whether and how osteoporosis risk is increased after gastrectomy in patients with gastric cancer.


A total of 1204 patients (802 men) from 19 cohort studies were included. We evaluated the prevalence of osteoporosis in postgastrectomy patients, comparing the incidence according to the type of gastrectomy and sex. Additionally, we evaluated changes in bone mineral density (BMD) and bone metabolism-related markers pre- to postoperatively and between patients who underwent gastrectomy and matched controls. Proportion meta-analysis was performed and pooled odds ratios (ORs) were calculated.


The pooled incidence estimate was 36% [95% confidence interval (CI), 32–40]. The incidence of osteoporosis was significantly higher in women than in men (OR = 1.90, p < 0.001) but was similar between partial and total gastrectomy groups (OR = 0.983, p = 0.939). BMD was significantly decreased, and calcium, phosphorous, and parathyroid hormone levels were significantly increased in patients after gastrectomy compared to those before gastrectomy. BMD and calcium and 25OH-vitamin D levels were significantly decreased, and parathyroid hormone and 1,25OH-vitamin D levels were significantly increased in the gastrectomy group compared to that in the control group.


We found that BMD is significantly decreased after gastrectomy in patients with gastric cancer. Vitamin D deficiency and secondary hyperparathyroidism are suggested to be common mechanism underlying BMD impairment. After resection, patients should undergo long-term nutritional and bone health surveillance, in addition to their oncological follow-up.


Bone mineral density Gastrectomy Gastric cancer Osteoporosis Parathyroid hormone Vitamin D 


Funding information

This study was funded by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea [grant number: HI18C0284].

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

This meta-analysis summarizes previously published data and does not include new human data or tissue that requires ethical approval and consent. The authors assume that the studies reviewed were conducted after ethical approval and consent and in accordance with the Declaration of Helsinki.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and DetectionNational Cancer CenterGoyang-siRepublic of Korea
  2. 2.Department of Orthopaedic Surgery, Inje University College of MedicineSeoul Paik HospitalSeoulRepublic of Korea
  3. 3.Department of Orthopaedic Surgery, College of MedicineChung-Ang UniversitySeoulRepublic of Korea
  4. 4.College of PharmacyChung-Ang UniversitySeoulRepublic of Korea
  5. 5.College of PharmacyDaegu Catholic University Gyeongsan-si,GyeongbukRepublic of Korea
  6. 6.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnam-siRepublic of Korea
  7. 7.Department of Orthopedic SurgerySeoul National University College of MedicineSeongnam-siRepublic of Korea

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