High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease

Kuwabara, Akiko; Tanaka, Kiyoshi; Tsugawa, Naoko; Nakase, Hiroshi; Tsuji, Hideaki; Shide, Kenichiro; Kamao, Maya; Chiba, Tsutomu; Inagaki, Nobuya; Okano, Toshio; Kido, Shoko

doi:10.1007/s00198-008-0764-2

Cited by 95 publications

(59 citation statements)

References 46 publications

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“…In a more recent analysis in Japanese IBD patients, similar vitamin K deficiency was documented and shown to be more prominent in CD that in UC (59). Undercarboxylated osteocalcin was also elevated in CD patients.…”

Section: Vitamin K Status In Ibd Patientsmentioning

confidence: 71%

“…Undercarboxylated osteocalcin was also elevated in CD patients. There was no significant difference in vitamin K intake between CD and UC; therefore, malabsorption of vitamin K was postulated to be the likely contributor (59). Although vitamin K absorption in inflammatory conditions has not been studied, one case report with a small bowel CD patient treated with warfarin for deep vein thrombosis showed resistance to oral vitamin K for reversal of overanticoagulation (37).…”

Section: Vitamin K Status In Ibd Patientsmentioning

confidence: 99%

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Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Ghishan

Kiela

2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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Ghishan FK, Kiela PR. Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases. Am J Physiol Gastrointest Liver Physiol 300: G191-G201, 2011. First published November 18, 2010 doi:10.1152/ajpgi.00496.2010.-Chronic inflammatory disorders such as inflammatory bowel diseases (IBDs) affect bone metabolism and are frequently associated with the presence of osteopenia, osteoporosis, and increased risk of fractures. Although several mechanisms may contribute to skeletal abnormalities in IBD patients, inflammation and inflammatory mediators such as TNF, IL-1␤, and IL-6 may be the most critical. It is not clear whether the changes in bone metabolism leading to decreased mineral density are the result of decreased bone formation, increased bone resorption, or both, with varying results reported in experimental models of IBD and in pediatric and adult IBD patients. New data, including our own, challenge the conventional views, and contributes to the unraveling of an increasingly complex network of interactions leading to the inflammationassociated bone loss. Since nutritional interventions (dietary calcium and vitamin D supplementation) are of limited efficacy in IBD patients, understanding the pathophysiology of osteopenia and osteoporosis in Crohn's disease and ulcerative colitis is critical for the correct choice of available treatments or the development of new targeted therapies. In this review, we discuss current concepts explaining the effects of inflammation, inflammatory mediators and their signaling effectors on calcium and phosphate homeostasis, osteoblast and osteoclast function, and the potential limitations of vitamin D used as an immunomodulator and anabolic hormone in IBD.bone mineral density; Crohn's disease; osteopenia; osteoporosis; ulcerative colitis INFLAMMATORY BOWEL DISEASES (IBDs) represent a group of chronic inflammatory disorders of the intestinal tract that to this date remains idiopathic. More recent basic and clinical research indicates that the chronic inflammatory reaction of the intestinal mucosa is directed against the gut microbiota in individuals with genetic and/or environmental susceptibilities. Disease onset occurs typically during young adulthood (25-35 yr), although ϳ20 -25% of cases are diagnosed during childhood (93). On a clinical basis, two major subtypes of IBD are defined as Crohn's disease (CD), which potentially affects any part of the gastrointestinal tract from the mouth to the anus, and ulcerative colitis (UC), an inflammatory condition limited to the colonic mucosa. However, IBD does not affect just a single organ and should be considered a systemic disease with several extraintestinal manifestations, which occur in a large proportion of IBD patients (60). Osteopenia and osteoporosis are two of the more common extraintestinal symptoms with a general consensus that IBD patients are at a significantly higher risk of developing metabolic bone disease and low bone mineral density (BMD) than the healthy subjects. The relative risk of fractur...

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Section: Vitamin K Status In Ibd Patientsmentioning

confidence: 71%

Section: Vitamin K Status In Ibd Patientsmentioning

confidence: 99%

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Ghishan

Kiela

2011

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Malabsorption rather than dietary insufficiency is the likely main underlying mechanism leading to fat-soluble vitamin deficiencies [Kuwabara et al 2009] which, in turn, can be associated with metabolic bone disorders [Kuwabara et al 2009]. Vitamin D deficiency can, of course, result in osteomalacia.…”

Section: Protein Energy Malnutritionmentioning

confidence: 99%

Nutritional management of Crohn’s disease

Donnellan

Lee

Lal

2013

Therap Adv Gastroenterol

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Nutritional care and therapy forms an integral part of the management of patients with Crohn's disease (CD). Nutritional deficiencies result from reduced oral intake, malabsorption, medication side effects and systemic inflammation due to active disease. Enteral nutrition has a role in support for the malnourished patient, as well as in primary therapy to induce and maintain remission. The use of parenteral nutrition in CD is mainly limited to the preoperative setting or for patients with intestinal failure, but does not offer any additional advantage over EN in disease control. Dietary modifications, including eliminationreintroduction diets and a low fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet may improve symptoms but there are currently no data to suggest that these approaches have any role in the induction or maintenance of remission.

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“…Kuwabara et al observed greater bone mineral density (BMD) deficiencies in the distal radius (cortical bone) compared with the lumbar spine (trabecular bone). This suggests factors other than glucocorticoid use (e.g., nutritional deficiency) as a contributing component to the osteoporosis burden in IBD [36]. van Staa et al also demonstrated an increase in fractures after adjusting for corticosteroid use [37].…”

Section: Nutritional Deficienciesmentioning

confidence: 94%

Diet, nutrition and inflammatory bowel disease

Hou¹,

Sellin²

2010

Therapy

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High prevalence of vitamin K and D deficiency and decreased BMD in inflammatory bowel disease

Abstract: IBD patients have high prevalence of decreased BMD and vitamin K and D deficiency probably caused by malabsorption of these vitamins.

Cited by 95 publications

References 46 publications

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Nutritional management of Crohn’s disease

Diet, nutrition and inflammatory bowel disease

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