Secondary hyperparathyroidism with severe osteoporosis after bilio-pancreatic diversion: clinical case report

Kim, E.; Ershova, E.; Troshina, E.

Авторы: Kim E., Ershova E., Troshina E.
Журнал: Osteoporosis International
Том: 32
Номер: S1
Год издания: 2021
Издательство: Springer Verlag
Местоположение издательства: Germany
Первая страница: 119
Последняя страница: 410
DOI: 10.1007/s00198-021-06125-9
Аннотация: Objectives: Obesity is an important public health scourge worldwide,which lately reached epidemic proportion. Bariatric surgery is the mosteffective way to cut and maintain weight among patients with morbidobesity. One of the methods is biliopancreatic diversion (BPD) which hasthe most frequent complications associated with macro- andmicronutrient malabsorption.Methods: We present a case of a 50-year-old female patient withsecondary osteoporosis developed into severe osteoporosis after a BPDtreatment performed 6 years previously. In the postoperative period, thenecessary replacement therapy with calcium, vitamin D and other microand macronutrients had been taken irregularly; no long-term laboratorymonitoring was provided due to the lack of appropriaterecommendations. On admission, she was not able to move because ofsevere pain and edematous syndromes, her height decreased by 10-12 cm.The DXA confirmed severe osteoporosis (T-score of radius total -5.6 SD,L1-L4 -3.4 SD and total hip -4.2 SD). The X-ray demonstrated multipleconsolidated fractures of ribs. The laboratory data indicated severehypoproteinemia (total protein 38 g/L), hypocalcemia (ionized calcium0.99 mmol/l), 25(OH) vitamin D deficiency (5.6 nmol/l) and an increasedrate of PTH (562,6 pg/ml). Ultrasound revealed signs of hyperplasia ofthe right upper parathyroid gland (1.0 x 0.8 x 0.4 cm).Results: Our treatment started with enhanced infusion therapy of albuminand diuretics with the response of positive diuresis and a loss of excessfluid. Next, the therapy aimed to replenish the deficiency of calcium(calcium carbonate 2 g), vitamins A, D (cholecalciferol 800 IU andalfacalcidol 2 μg), E, B, iron, folic acid, digestive enzymes and protein.Long-term bisphosphonate therapy is prescribed after normalization ofcalcium-phosphorus metabolism. Upon reexamination after the relief ofthe malabsorptive syndrome and an improvement of general somaticstate. During 2 years of follow-up, the patient moved independently,did not presented new fractures; an increase of BMD was observed (Tscore of radius total -5.1 SD, L1-L4 -2.3 SD and total hip -2.4 SD), thelaboratory test showed normalization of biochemical parameters.Conclusion: The lack of compulsory lifelong replacement therapy and afollow-up management leads to side effects, including severeosteoporosis due to malabsorption related vitamin D deficiency.Keeping all risk factors for osteoporotic fractures under control isnecessary to prevent a decrease of life quality in the extreme case ofpatient's disability
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Secondary hyperparathyroidism with severe osteoporosis after bilio-pancreatic diversion: clinical case reportстатья Тезисы

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