BIOLOGICS AND JAK INHIBITORS EFFICACY IN VEXAS SYNDROME FROM FRENCH MULTICENTER CASE SERIES OF 256 PATIENTS
Authors: Chacur C.A. et al.
The development of osteoporosis and even osteomalacia is a well-documented complication of bariatric surgery (BS). In this retrospective cohort study from Spain the prevalence of osteomalacia and the main clinical characteristics of 46 subjects (aged 42-77 years) with previous BS referred to the Rheumatology Department for osteoporosis treatment were analyzed.
Five of the 46 patients (10.8%) presented criteria compatible with osteomalacia, two being confirmed by bone biopsy. All subjects with osteomalacia were Caucasian and most were women (4/5) treated with malabsorptive surgery (mainly Roux-en-Y gastric bypass). All presented with increased serum alkaline phosphatase. Most subjects had low serum calcium (4/5) and vitamin D serum levels; the latter were markedly decreased in 4 individuals (with only one presenting values >20 ng/ml). Parathyroid hormone (PTH) levels were increased in all subjects. Bone densitometry in most (4/5) showed values compatible with osteoporosis. 4 individuals developed fractures/pseudofractures after BS. Three of these subjects were poorly adherent to calcium and vitamin D supplements and in 2 cases higher doses of calcium (3 g/day) and/or parenteral vitamin D administration were necessary to achieve serum vitamin D levels >30 ng/ml and decrease of serum PTH levels.
Among the remaining 41 subjects, 28 (68%) presented densitometric osteoporosis and 18 (45%) developed fractures (mainly vertebral) after BS.
Bone health is a major problem in patients undergoing bariatric surgery and osteomalacia may occur in these patients due to vitamin D deficiency. After bariatric surgery patients need to be closely monitored and adequate vitamin D and calcium supplementation are very important. If the 25-OH vitamin D level remains low despite peroral vitamin D administration, vitamin D should be administered parenterally in these patients.