AB1245 OSTEOMALACIA RELATED TO BARIATRIC SURGERY: HOW FREQUENT IS IT?

Background The development of osteoporosis and fractures is a well-documented complication bariatric surgery (BS), especially with procedures associated malabsorption. Due to the gradual increase BS performed worldwide, several national international societies have developed clinical guidelines for managing these patients, special attention prevention treatment. Nevertheless, subjects can also develop osteomalacia, which easily be misdiagnosed as osteoporosis. It crucial differentiate osteomalacia in patients since different therapeutic approaches are necessary. Objectives To analyse prevalence main characteristics previous referred Rheumatology Department Methods This was retrospective study cohort 46 (aged 42-77 years) Metabolic Bone Diseases Unit evaluating Clinical data were obtained from an in-depth review medical records, including type (restrictive: gastric banding, sleeve gastrectomy, or malabsorptive surgery: Roux-en-Y bypass [RYGB], biliopancreatic diversion duodenal switch), time surgery, treatment calcium and/or vitamin D, anthropometric data, clinical, laboratory, radiologic densitometric findings. Osteomalacia diagnosed by compatible bone biopsy Bingham Fitzpatrick criteria [1] (two following: low calcium, phosphate, elevated total alkaline phosphatase [TAP] suggestive radiology). Results Five (10.8%) presented two being confirmed biopsy. All Caucasian most women (4/5) treated (mainly RYGB) 4 23 years prior visit. increased serum TAP values (some presenting progressive 1-3 visit). Most showed D levels; latter markedly decreased individuals (with only one >20 ng/ml). Parathyroid hormone (PTH) levels all subjects. scan pattern evaluated (4/4) densitometry (4/5), four developing fractures/pseudofractures after BS. Three poorly adherent supplements 2 cases higher doses (3 g/day) parenteral administration necessary achieve >30 ng/ml decrease PTH posterior follow-up. Of note, no subject suspicion osteomalacia. Among remaining 41 subjects, 28 (68%) 18 (45%) vertebral) BS; primary hyperparathyroidism (treated surgery). Again, frequent surgical procedure Conclusion Nearly 10% may Increased should alert clinicians this diagnosis it requires differential approach some needing high even supplementation. Reference [1]Bingham CT, LA. Non-invasive testing Am J Med 1993; 95(5):519-23. Acknowledgements: NIL. Disclosure Interests None Declared.