Men's Osteoporosis Support GroupHemodialysis, sun tan spray, and gastrointestinal bypass surgery BMC Musculoskelet Disord. 2009 Jun 4;10(1):60. [Epub ahead of print]. Factors associated with low bone mass in the hemodialysis patients- A cross-sectional correlation study. Huang GS and others. PMID: 19497099. End-stage renal disease patients, especially those undergoing hemodialysis, are at risk for osteoporosis and bone fractures. This study was done to find the risk factors for those problems. The study involved 63 patients who had been on hemodialysis for at least six months. The authors found that, "This study showed that advanced age, low BW [body weight], low serum albumin level, and high ALP and iPTH levels were associated with a low bone mass in the hemodialysis patients." For individuals undergoing dialysis, the authors recommended ". . .regular monitoring of the femoral neck BMD, maintaining an adequate serum albumin level and BW, and undertaking an exercise program are important to improve bone health are important to improve bone health in patients undergoing hemodialysis." Editor's comments. This study highlights the importance of hemodialysis patients and their physicians being aware that osteoporosis, and fractures this causes, are a risk when undergoing hemodialysis. Regular bone density testing should be performed and FDA-approved osteoporosis medications should be started if warranted by the results of these tests. Photochem Photobiol. 2009 May 28. [Epub ahead of print]. Do Melanoidins Induced by Topical 3% Dihydroxyacetone Sunless Tanning Spray Inhibit Vitamin D Production? A Pilot Study. Armas LA and others. PMID: 19496990. This was a pilot study, meaning that causal relationships can't be drawn from its results. But it suggests that sunless tanning spray with 3% dihydroxyacetone (DHA) can have a deleterious effect on some individuals' serum 25-hydroxyvitamin D [25(OH)D] levels. Since it has been shown in multiple other studies that it is important to monitor your serum vitamin D levels to assure proper absorption of calcium from the gut, this would seem to be even more important for any individuals who use this form of sunless tanning spray. Hopefully additional studies will report on exactly how negatively this spray impacts vitamin D production. Until then, if you use this spray, have routine serum vitamin D testing done to be sure you are not putting yourself at risk of osteoporosis with this tanning spray. Endocr Pract. 2009 Jun 2:1-16. [Epub ahead of print]. Osteomalacia with Bone Marrow Fibrosis Due to Severe Vitamin D Depletion Following Gastrointestinal Bypass Surgery for Severe Obesity. Al-Shoha A and others. PMID: 19491072. These authors reported on five individuals who had undergone gastric bypass surgery for severe obesity over a 17-year period. All had generalized bone pain and tenderness, muscle weakness, stooping posture, difficulty walking, and waddling gait due to severe proximal muscle weakness for a period of 2 to 5 years. Each person had highly suggestive biochemical and/or radiological findings of osteomalacia, which was confirmed by bone biopsy. Patients required 100,000 I.U. of ergocalciferol daily and 1 to 2.5 grams of calcium carbonate per day to alleviate their clinical symptoms. The authors concluded, "Gastric bypass surgery predispose[s] to severe vitamin D deficiency and osteomalacia in the absence of pharmacologic doses of vitamin D therapy." Editors comments. I have discussed the association between gastric bypass surgery and osteoporosis in this Update. and in another 2004 Update. The Al-Shoha and others study makes it clear that gastric bypass complications can go even beyond osteoporosis to osteomalacia. Individuals who have this procedure done need to be aware of the potential problems due to malabsorption of vital nutrients, especially vitamin D and calcium. Patients must assure that their care providers do routine bone density testing, perhaps along with tests for biochemical markers of bone breakdown, and serum vitamin D testing. This study shows that "normal" intake of vitamin D and calcium is grossly inadequate for some bypass patients and they will need very high oral doses in order to absorb adequate amounts of vitamins or minerals. Additionally, it would appear that outdoor activities would be important for these individuals to allow adequate skin exposure to the sun which also forms vitamin D.
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