Hypocalcemia and osteomalacia after bariatric surgery.

Introduction: Obesity has become a major health problem not only in industrialized societies but also in developing countries. Multiple studies have shown that bariatric surgery has been effective in reducing substantial amount of weight and also the comorbidities and is being performed more frequently as an established treatment. Due to anatomical and physiological alterations after surgery that impairs absorption of vitamin D and calcium, two fundamental factors in bone formation, their intestinal absorption is highly compromised.

Case report: We present a 48-year-old woman who was visited in emergency room for generalized bone pain, perioral paresthesia and carpopedal spasm. She had undergone bariatric surgery 15 years ago. Chvostek's sign and Trousseau's sign were positive. Examination of thoracic ribs elicited severe pain on palpation. Laboratory evaluation revealed: Ca = 6.1 mg/dL, P= 2.1 mg/dL, alkaline phosphatase = 432 (160-303), PTH=541 pg/mL, and 25(OH)D₃= 3 ng/mL. Whole body bone scan showed increased uptake in the anterior arc of left 6^th rib, posterior arc of left 6^th and 12^th ribs with increased uptake of costochondral joints.

Conclusion: Our case highlights the possible consequences that bariatric surgery may have on bone and mineral health and the need for regular and proactive follow-up of the patients.