Calcium and vitamin D depletion and elevated parathyroid hormone following biliopancreatic diversion

Obes Surg. 2003 Dec;13(6):893-5. doi: 10.1381/096089203322618722.


Background: Biliopancreatic diversion (BPD) is associated with a 70% excess weight loss (EWL) at 10 years, but there are concerns regarding long-term nutritional sequelae. Metabolic bone disease has been documented following Roux-en-Y gastric bypass.

Methods: Patients who underwent a BPD from 1998 to 2001 were studied. A questionnaire was designed to review BPD patients and collect information on weight loss, frequency of gastrointestinal disturbances and compliance with multivitamin recommendations. The review included a blood test for vitamin D, parathyroid hormone (PTH), alkaline phosphatase (ALP) and calcium.

Results: Of the 82 patients who underwent BPD during this period, the median %EWL at 36 months was 73.0%. 75.6% suffered diarrhea. At median follow-up of 32 months (18-50), 25.9% of patients were hypocalcemic, 50% had low vitamin D, 23.8% had elevated ALP, and 63.1% had elevated PTH, despite 82.9% taking multivitamins.

Conclusion: BPD results in significant weight loss. However, 1 in 4 patients are hypocalcemic, and 1 in 2 have a low vitamin D, despite multivitamin supplementation. BPD patients require routine calcium and vitamin D supplementation for life. Long-term sequelae from these abnormal serum levels are not known.

MeSH terms

  • Alkaline Phosphatase / blood
  • Anastomosis, Roux-en-Y / adverse effects
  • Biliopancreatic Diversion / adverse effects*
  • Bone Diseases, Metabolic / blood
  • Bone Diseases, Metabolic / etiology*
  • Calcium / blood
  • Female
  • Gastrectomy / adverse effects
  • Gastric Bypass / adverse effects*
  • Humans
  • Hypocalcemia / blood
  • Hypocalcemia / etiology*
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery
  • Parathyroid Hormone / blood
  • Vitamin D / blood
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / etiology*


  • Parathyroid Hormone
  • Vitamin D
  • Alkaline Phosphatase
  • Calcium