Bone Loss After VSG

I just had a bone density test done at the one year post WLS. I had a baseline done previous to surgery and the most recent test showed an average of about 10% loss amongst the 3 markers that are used to measure bone density. The values are still within normal range, but this is a significant change in just one year.

Have other people experienced this?

I weight train for 2 hours/week, walk daily, take calcium citrate 1500 mg/day, VitD3 5,000-10,000 u/day, consume about 3 servings of dairy/day. My recent labs were normal, although, my Vit D was elevated at 115.

Gail

So depressing!  I have read this, but mostly in context of malabsorptive surgeries, particularly the DS. Are you still taking PPIs? They can interfere with calcium absorption. I was diagnosed with ostepenia a loong time ago--I think about 14 years ago, when I was 43. During the last year, it has slipped into full blown osteoporosis. It does run in my family as my mother had severe osteoporosis and my sister, 2 years younger and always of a normal weight, was diagnosed with osteoporosis a couple of years ago. Unfortunately, I still do need to take high doses of PPIs because of a faulty stomach valve, plus I tend to get high serum calcium if I go over 1200 mg/day of calcium. Anyway, it sucks. But both my endo and my PCP tend to think that it is not the fault of the VSG, rather it has to do with menopause (the first years after are the worst, apparently, for bone loss) and a natural progression. However, in your case, such a dramatic loss in one year is scary. I'd see an endo to get all the bone marker tests done (if you haven't already). Mine are all normal...I go back for another scan next month and we'll see what has happened...

Lizanne

Thanks, Lizzy.

Two things, yes, I am still on a PPI and prior to surgery, I had been taking estradiol for menopausal symptoms. Maybe, it is a combination of the two? I sent an e-mail to my PCP asking for further clarification and guidance. I was very surprised.

I'm glad you posted this, though sorry that you have osteoporosis.  

I had a parathyroid tumor removed last year, found during my pre-op lab for VSG.  Because of the tumor sucking the calcium out of my bones, I have osteoporosis in my wrists and spine and osteopenia in my hips.  I'll have a followup bone scan 2 years post-op, so I'm very interested in the outcome.  

I wasn't aware until I read it here recently, that PPI can inhibit calcium absorbption.  My Endocrinologist has me taking  1600 - 1800 mg of calcium daily and my last calcium level was good.  My vitamin D level is maintaining taking 400 iu daily.  I've cut back on the PPI but will work on stopping them completely....Thanks for the warning. 

I need to be more diligent with the weight training...something to thing about more seriously.  

Hi Birdie,

I haven't been diagnosed with osteoporosis, but from my baseline bone density test prior to surgery, I have significant bone loss (about 10 %), although, the values are still within the normal range.

I think, I'll increase my calcium, increase my load bearing exercise, and try to wean off the PPI. I still need to take an acid reducer, since I have to take baby aspirin for a cardiac condition.

I've been doing the right things and have been proactive in my care and some things are beyond our control. 

Gail

I'm so sorry  that you are having this problem.

How do they scan for bone density?  I've never had this done and am pushing 50, in pr-meno, take PPI's, and have had VSG.   I was thinking maybe I should talk to my doc about getting tested, so that I have a baseline test for future reference. 

Thank you for posting this.

Trish, tell your Gyn you want a DEXA scan.  It would be good to get a baseline at 50.  As to bone loss, I has a 15% drop on my last DEXA scan.  I am considered osteopenic, which is the step before osteoporosis.  I had the baseline scan done 2 years ago, and the new one just recently.  About 8 months post VSG.  I do not take PPL's.  I do strength training and take calcium supplements.  I've had an oophorectomy ( ovaries removed) about 2 1/2 years ago.  I hope the osteopenia is not related to my VSG, but to the lack of estrogen, just don't know.  My doctor wants me on bone replacement drugs.  I don't want to do it, the side effects look terrible.  So I am also interested in other responses you receive.  Good post.

Thank you marie, I'll talk to my GYN about gatting the DEXA scan.  Gosh I'm glad this was brought up.  I to am hoping more people respond.

What's your PTH like? If it's high, it's a sign your body is taking calcium from your bones to maintain your serum calcium levels. And, by high, I mean anything over about 40 which is still considered normal.

Unfortunately, a serum calcium level of normal doesn't really tell us much because our body works very hard to preserve our serum levels within a very narrow range. That's why you have to look at calcium along with PTH and Vitamin D and not in isolation. Low Vitamin D often means you aren't absorbing the calcium you do take and high PTH means your body is leaching calcium from your bones to keep your serum calcium levels in line. (Your Vitamin D is good so this is more general info than directed at you.)

Btw, a HIGH serum calcium level is often a sign of not getting enough calcium. The solution is to take MORE calcium not less. The reason this happens is that our bodies need the calcium to be a certain range to protect the heart so our bodies make PTH in order to get the calcium out of our bones but then the body gets overly aggressive and pulls to much which makes our serum levels high.

Osteoporosis is a known complication of partial gastrectomies which is why all WLS peeps are on large doses of calcium. It's because our stomachs have very little stomach acid. This is true even after we are off a PPI. It runs in my family so I am very watchful of it. I am very faithful to my calcium and vitamin D supplementation. I also do a lot of heavy lifting and running which is also a load bearing exercise. None of this is a guarantee I won't get osteoporosis but adding strength training and walking to her life helped my mom turn back osteopenia so I'm hopeful it will be enough for me.

My baseline Dexa scan showed me as being normal for my age and in every area but one I compared favorably to the 35  year old baseline so that's good. Of course, being the driven person I am, I want that one measure that was negative to switch over to the positive even though I'm in the normal range for both my age and the 35 year old baseline. I guess we'll see when I get my next scan.

I am aware that WLS increases the risk of osteoporosis, which is why I asked for a baseline DEXA Scan prior to surgery. I have been taking calcium citrate 1500 mg/day, Vit D, strength train (including heavy lifting cycles) for 2 hours/week, stair climb, walk. I could add in another day of strength training and do more jogging. Spinning is not load bearing, except for the resistance part of it. Step aerobics isn't my thing, so I need to work on jogging and other weight bearing exercise. Apparently, walking isn't enough. We need that heel strike that load bearing exercise causes.

The feedback mechanism between PTH, CA, and Vit D is very interesting and I do understand that serum CA levels don't tell the full story. I really enjoyed reading your explanation of the feedback mechanism and how all 3 components interact with one another. The body is an amazing work of art and design.


My recent labs were good: PTH: 17, CA 9.5, and Vit D 116

Six months ago, PTH was 10, CA 9.9, Vit D 86.

So, maybe the bone loss occurred during the period of rapid weight loss? Interesting..

My baseline was good and compared favorably to the WHO standards for a 30 year old woman in all areas. I have lost 10% of that in one year. I'm still within the norm, and don't want it to decrease further.



Gail