Osteoporosis and Hepatic Steatosis: 2 Closely Related Complications in Short‐Bowel Syndrome

Abstract

Background Osteoporosis has scarcely been prospectively investigated in short‐bowel syndrome (SBS). This prospective study was designed to evaluate incretins, adipokines, bone mass, and lipid deposits from marrow adipose tissue (MAT), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver (IHLs). Methods The study comprised 2 groups matched by gender, height, and age: the control group (CG) (9 males, 9 females) and the SBS group (SBSG) (6 males, 5 females). The SBSG was evaluated twice in an interval of 1 year (SBSG0 and SBSG1). The biochemical evaluation included incretins, leptin, and adiponectin. Dual‐energy x‐ray absorptiometry and magnetic resonance were, respectively, used to measure BMD and lipid deposits. Results Bone mineral density (BMD) was lower in the SBSG than in the CG, but there was no difference between SBSG0 and SBSG1. There was no difference in MAT, SAT, and VAT, but IHL was lower in CG than in SBSG0 and SBSG1. A negative correlation between MAT and third lumbar vertebrae BMD was found in the CG but not in SBSG0 or SBSG1. There was a negative association between IHL and bone mass considering all participants (CG and SBSG0) (R2 = 0.38; P < .05). Conclusion Appropriate nutrition assistance recovers body composition, reverts the relationship of bone mass and MAT, and mitigates bone loss in SBS. In spite of this, osteoporosis seems to be an early and persistent complication in SBS. Curiously, SBS seems to be a highly vulnerable condition for the development of hepatic steatosis and shows an association between bone mass and IHL.

Hashtag bone: detrimental effects on bone contrast with metabolic benefits one and five years after Roux-en-Y gastric bypass

“…The observed normal HOMA-IR values and serum glucose, insulin, ALT, and AST levels after RYGB reflect an improved metabolic status. The metabolic environment in patients submitted to RYGB contrasts with that observed in individuals with short bowel syndrome, who are prone to present persistent hepatic steatosis after withdrawal of parenteral nutrition ( 23 ).…”

“…Insulin resistance and its related disorder, nonalcoholic fatty liver disease (NAFLD), are two of the most common and severe complications associated with obesity. According to previous studies, hepatic accumulation of fat is negatively associated with bone mass in individuals with short bowel syndrome ( 22 , 23 ). However, studies evaluating the association of NAFLD and bone in individuals with obesity and T2DM have shown conflicting results, suggesting that factors other than the amount of intrahepatic lipids (IHL) mediate the relationship between liver and bone ( 24 , 25 ).…”

Refining Evaluation of Bone Mass and Adipose Distribution in Dunnigan Syndrome

“…The 1 H-MRS proton magnetic resonance spectroscopy was performed using the Point Resolved Spectroscopy (PRESS) technique with 16 acquisitions with water suppression and a flip angle of 90 • , as follows: TR: 1600 ms; TE's: 30/45/60/75/90 ms. Data were processed using LCModel software (Version 6.1, http://www.s-provencher.com/pages/lcmodel.shtml, accessed on 25 September 2021), and the values obtained were used to calculate fat fractions (saturated and unsaturated lipids). The BMAT content and saturated fat fraction in L3 were estimated as previously described by Parreiras-e-Silva et al [46]. Due to claustrophobia, 5 controls and 4 DS patients did not undergo lumbar spine MRI.…”

Bone, fat, and muscle interactions in health and disease

“…This aspect may determine significant differences between SBS and the two other conditions (anorexia nervosa and bariatric surgery) from a metabolic point of view, but from the perspective of bone, the three conditions share negative consequences on the skeleton ( 76 ). Indeed, individuals with SBS have a high prevalence of osteoporosis and hepatic steatosis ( 77 , 78 ). Another aspect is that the parenteral supply of nutrients in SBS not only seems to limit MAT expansion but also changes the pattern of correlation between MAT and bone mass, which in this case is positive, suggesting that – depending on the circumstances – MAT may have a positive or negative effect on the maintenance of bone mass.…”