Calcium gluconate supplementation is effective to balance calcium homeostasis in patients with gastrectomy
Calcium gluconate supplementation is effective to balance calcium homeostasis in patients with gastrectomy
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DOI：
10.1007/s00198-014-2965-1
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发表时间：
2015-03-01
影响因子：
4
通讯作者：
Amling, M.
中科院分区：
文献类型：
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作者：
Krause, M.;Keller, J.;Amling, M.
总结我们证明了胃切除患者甲状旁腺功能亢进症的组织学证据。这至少部分是由于钙吸收受损，导致矿化缺陷和继发性甲状旁腺功能亢进。此外，我们还发现，在接受葡萄糖酸盐治疗的胃切除患者中，骨矿化得到了改善，同时也证明了相比碳酸盐，葡萄糖酸钙可以有效地平衡小鼠体内受损的钙止血作用。介绍：胃切除手术和长期服用质子泵抑制剂导致的低盐血症与肠道钙吸收不良导致的骨折风险增加有关。因此，我们的目标是对胃切除患者的骨代谢进行组织学研究，并分析在胃酸受损的情况下补充葡萄糖酸钙对骨骼完整性的影响。方法对26例胃切除患者的未脱钙骨活检进行组织学分析。在临床环境中，我们回顾性地确定了5名维生素D水平足够的胃切除患者，他们补充了葡萄糖酸钙，并进行了真实的骨密度(ABMD)随访评估。采用小鼠失弛缓症(ATP4b-/-)模型，比较补充葡萄糖酸钙和碳酸钙对骨代谢的影响。结果与健康对照组相比，胃切除患者的活检组织中类骨质、破骨细胞和成骨细胞指数显著增加，纤维破骨(p<；0.05)，矿化骨基质中钙分布受损。5名维生素D水平足够的胃切除患者在单独使用葡萄糖酸钙治疗至少6个月后，骨密度显著增加(p<；0.05)。在胃酸缺乏的小鼠模型中，葡萄糖酸钙在维持钙代谢方面优于碳酸钙。我们发现，补充葡萄糖酸钙可以增加胃切除患者的骨密度，在恢复腹泻症小鼠模型中的钙/骨骼稳态方面优于碳酸钙。
A Summary We demonstrate histological evidence for hyperparathyroidism in patients with gastrectomy. This is, at least in part, explained by impaired calcium absorption, resulting in mineralization defects and secondary hyperparathyroidism. Additionally, we demonstrate improved bone mineralization in patients with gastrectomy after gluconate therapy and showed the effectiveness of calcium gluconate over carbonate to balance impaired calcium hemostasis in mice.Introduction Gastrectomy and hypochlorhydria due to long-term proton pump inhibitor therapy are associated with increased fracture risk because of intestinal calcium malabsorption. Hence, our objectives were to histologically investigate bone metabolism in patients with gastrectomy and to analyze the impact of calcium gluconate supplementation on skeletal integrity in the setting of impaired gastric acidification.Methods Undecalcified bone biopsies of 26 gastrectomized individuals were histologically analyzed. In the clinical setting, we retrospectively identified 5 gastrectomized patients with sufficient vitamin D level, who were additionally supplemented with calcium gluconate and had a real bone mineral density (aBMD) follow-up assessments. A mouse model of achlorhydria (ATP4b-/-) was used to compare the effect of calcium gluconate and calcium carbonate supplementation on bone metabolism.Results Biopsies from gastrectomized individuals showed significantly increased osteoid, osteoclast, and osteoblast indices and fibroosteoclasia (p < 0.05) as well as impaired calcium distribution in mineralized bone matrix compared to healthy controls. Five gastrectomized patients with sufficient vitamin D level demonstrated a significant increase in aBMD after a treatment with calcium gluconate alone for at least 6 months (p < 0.05). Calcium gluconate was superior to calcium carbonate in maintaining calcium metabolism in a mouse model of achlorhydria.Conclusion Gastrectomy is associated with severe osteomalacia, marrow fibrosis, and impaired calcium distribution within the mineralized matrix. We show that calcium gluconate supplementation can increase bone mineral density in gastrectomized individuals and performs superior to calcium carbonate in restoring calcium/skeletal homoeostasis in a mouse model of achlorhydria.