Osteoporosis in Gastrointestinal Diseases

Abstract

Secondary osteoporosis occurs as an isolated pathology or co-exists with types I and II osteoporosis. The gastroenterologist may come across osteoporosis or osteopenia in a patient with a gastrointestinal disease. This is often a young patient in whom investigations should be carried out and appropriate treatment initiated, aimed at preventing bone fractures and the formation of the best peak bone mass. Osteoporosis occurs in patients with the following conditions: Crohn's disease, ulcerative colitis, celiac disease, post gastrectomy patients, patients with short bowel syndrome, chronic hepatitis and cirrhosis, treated with steroids (steroid-induced osteoporosis) and patients using proton pump inhibitors chronically (state of achlorhydria). It is therefore necessary to approve a list of risk factors of secondary osteoporosis, the presence of which would be an indication for screening for osteoporosis, including a DXA study and the development of a separate algorithm for the therapeutic management of secondary osteoporosis accompanying gastrointestinal diseases, especially in premenopausal young women and young men, because there are currently no registered drugs with proven antifracture activity for this group of patients (Adv Clin Exp Med 2016, 25, 1, 185-190).

Pharmacologic Calcitriol Inhibits Osteoclast Lineage Commitment via the BMP-Smad1 and IκB-NF-κB Pathways

“…Because peak bone mass contributes to 60% of the osteoporosis risks, our findings suggest that administration of active vitamin D in the young may be beneficial by lowering osteoporotic risks in late life . More important, active vitamin D may be administered to young patients receiving cancer therapy or anti‐HIV treatment and young patients with inflammatory bowel diseases to improve the peak bone mass . On the other hand, recent studies have shown that supplementation with native vitamin D may not have any beneficial effect on the bone mass in children under normocalcemic conditions .…”

“…Peak bone mass is an important factor determining the risk of osteoporosis . Moreover, decreased peak bone mass is a common problem in young cancer patients receiving treatment, human immunodeficiency virus (HIV)‐infected patients, and young patients with inflammatory bowel diseases . Yet there are no drugs available to increase peak bone mass in these young patients .…”

“…(30) Moreover, decreased peak bone mass is a common problem in young cancer patients receiving treatment, human immunodeficiency virus (HIV)-infected patients, and young patients with inflammatory bowel diseases. (31)(32)(33) Yet there are no drugs available to increase peak bone mass in these young patients. (31) The present study reveals that calcitriol can increase the peak bone mass in mouse, mainly by inhibiting bone resorption.…”

Short bowel syndrome: influence of nutritional therapy and incretin GLP1 on bone marrow adipose tissue

“…The long‐term survival of these patients is achieved by efficient artificial replacement of nutrients . Despite the nutritional replacement, osteoporosis is a highly prevalent complication in SBS individuals . Sensitive to calorie restriction, MAT expansion occurs with decreased bone formation, which reinforces the fact that a shift in the differentiation of bone mesenchymal stem cells toward adipocytes occurs at the expense of osteoblasts .…”

“…The nutritional support not only permits short‐ and long‐term survival, but also allows physiological adaptation that leads to reacquisition or at least partial recovery of absorptive capacity . Osteoporosis is an undesirable consequence of SBS; previous studies reported an incidence of osteoporosis ranging from 21% to 67% in patients with SBS …”