Bone Disease

Bone disease such as osteoporosis, osteopenia and osteomalacia may also be more common in people who have had a gastrectomy although not all studies have found this to be true.  When you have osteoporosis, the strength and size of your bones is reduced.  Even a small injury may lead to broken bones. To maintain good bone health and prevent osteoporosis you should eat a balanced diet that includes adequate calcium and vitamin D, engage in regular physical activity, avoid heavy alcohol use and not smoke.  

It is possible that bone disease after gastrectomy may be due to reduced dietary intake of calcium and vitamin D, reduced absorption of calcium and /or vitamin D, and possibly changes in hormones that regulate bone metabolism.  Evidence for any of these factors is unclear.

Regardless, it is important to monitor bone density (DEXA) and vitamin D levels (25-OHD Vitamin D) as well as consume adequate amounts of calcium and vitamin D rich foods.   The current guidelines from the Institute of Medicine recommend a 25-OHD level of 20 mg/mL for good bone health.  The Institute of Medicine recommends an intake of 600 IU per day of vitamin D for those under the age of 70 years and 600 IU per day of vitamin D for those over age 70 years.  It is not safe to take levels of vitamin D beyond 4,000 IU per day.

Calcium recommendations for bone disease prevention are 1,000 mg / day for women 50 years and younger and men 70 years and younger.  For women 5 years and older and men over 70 years the recommendation is 1200 mg per day.  For patients with confirmed bone disease (based on bone mineral density test) or those at risk of bone disease your health care provider may recommend 1500 mg per day of calcium and 800 IU of vitamin D per day. The upper limits of safety for calcium are 2,500 mg a day.  The amount of calcium you get daily from the combination of food and supplemental calcium should not exceed 2500 mg per day.

Selected Calcium-Rich Foods

Food
Calcium (mg)
8 oz. yogurt without added fruit 400
Evaporated skim milk, ½ cup 400
Fortified oatmeal, 1 packet 350 (varies)
Sardines, canned in oil, with edible bones, 3 oz. 324
Cheddar cheese, 1½ oz. shredded 306
Milk, nonfat, 1 cup 302
Yogurt, plain, low-fat, 1 cup 300
Soybeans, cooked, 1 cup 261
Tofu, firm, with calcium, ½ cup 204
Orange juice, fortified with calcium, 6 oz. 200–260 (varies)
Salmon, canned, with edible bones, 3 oz. 181
Pudding, instant (chocolate, banana, etc.) made with 2% milk, ½ cup 153
Baked beans, 1 cup 142
Cottage cheese, 1% milk fat, 1 cup 138
Frozen yogurt, vanilla, soft-serve, ½ cup 103
Ready-to-eat cereal, fortified with calcium, 1 cup 100–1,000 (varies)
Turnip greens, bok choy, boiled, ½ cup 99
Broccoli, raw, 1 cup 90
Ice cream, vanilla, ½ cup 85
Soy or rice milk, fortified with calcium, 1 cup 80–500 (varies)

 

Selected Foods with Vitamin D

Food
Vitamin D (IU)
8 oz. milk 400
Fatty fish such as tuna, mackerel, and salmon 3-4 oz 360
Yogurt (varies) 40 -80
Fortified orange juice varies
Fortified soy milk varies
Margarine, 1 Tbs 60
Egg yolk, 1 25

 

Supplements

While food sources of calcium and vitamin D are best, it is often very difficult for people – especially those who have had a gastrectomy to get enough calcium and vitamin D by dietary sources alone.  Supplements are often necessary and recommended.

Calcium Supplements

Common calcium supplements include calcium carbonate, calcium phosphate and calcium citrate. These supplements contain different amounts of elemental calcium which is the actual amount of calcium in the supplement. It is important to read the label to determine the actual amount of calcium (elemental calcium) that is in the supplement. Calcium citrate does not require acid for absorption so is the best calcium supplement to take for someone who has had a gastrectomy.

Calcium is absorbed best when taken in small doses; therefore if you are taking 1500 mg per day, this should be taken as 500 mg calcium citrate three times per day. Vitamin D may be taken with the calcium or as a separate supplement. It may be easier to take a calcium supplement that includes vitamin D in the same compound but this is not necessary as long as the recommended level of vitamin D is taken the same day.

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