risk factors following gastrectomy for gastric cancer have been identified in a new pooled analysis, with female sex, older age, diabetes mellitus, anaemia, elevated alkaline phosphatase, and greater comorbidity burden all associated with increased risk.
Osteoporosis After Gastrectomy
Osteoporosis is recognised as a serious and highly prevalent complication among long term survivors of gastric cancer who have undergone gastrectomy. To better understand which individuals may be at greatest risk, researchers conducted a systematic review and meta-analysis of observational studies examining factors associated with osteoporosis after surgery.
The investigators searched four major databases from inception until 21 July 2025 and identified 11 eligible studies involving 232,814 subjects. Methodological quality was assessed independently by two reviewers using the Newcastle Ottawa Scale. The analysis focused on factors with clearly reported associations with osteoporosis in post gastrectomy populations.
Key Risk Factors Identified
The findings showed that female sex was strongly associated with osteoporosis risk (odds ratio [OR]: 2.30; 95% CI: 1.50–3.51; p<0.001). Older age was also linked to a higher likelihood of osteoporosis (OR: 1.06; 95% CI: 1.03–1.09; p<0.001).
Several clinical characteristics were similarly associated with increased risk. Diabetes mellitus was linked to osteoporosis (OR: 1.16; 95% CI: 1.07–1.25; p<0.001), while anaemia demonstrated a more pronounced association (OR: 2.20; 95% CI: 1.51–3.19; p<0.001). Elevated alkaline phosphatase levels emerged as one of the strongest predictors identified in the analysis (OR: 3.51; 95% CI: 1.35–9.12; p=0.010).
The data also indicated that a Charlson Comorbidity Index score greater than three was associated with increased osteoporosis risk (OR: 1.24; 95% CI: 1.08–1.41; p=0.002).
Potential Protective Association
Among the factors examined, urban residence was the only characteristic associated with a reduced likelihood of osteoporosis. This association was small but statistically significant, with residents of urban areas demonstrating a lower risk than those living elsewhere (hazard ratio: 0.87; 95% CI: 0.78–0.97; p=0.013).
The findings provide a clearer picture of which patients with gastric cancer may be more vulnerable to osteoporosis after gastrectomy. While some associations should be interpreted with caution because of limited available evidence, the results may help inform bone health surveillance and support future efforts to develop osteoporosis prevention strategies in this population.
Reference
Yan Y et al. Risk factors of osteoporosis in post-gastrectomy gastric cancer patients: a systematic review and meta-analysis. Sci Rep. 2026; DOI:10.1038/s41598-026-54726-3.
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