Gastrointestinal Diseases and Bone
Issue: 3/2017
Author: Temelkova, Natalia L., Popivanov, Plamen R.
Department of Clinical densitometry and Bone metabolic diseases, “Aleksandrovska” University Hospital, Sofia
Abstract:
Regardless of the significant improvement in the diagnosis and treatment of osteoporosis, it remains a socially significant disease with considerable mortality after fractures. Secondary osteoporosis is found in 50-60% of men, 60% of premenopausal women and 30% of postmenopausal women. In all ages, gastrointestinal diseases also increase and osteoporosis is often found as their complication. Systemic inflammation, malnutrition of calcium and vitamin D, secondary hypogonadism, and drug-induced bone loss are common causes of bone metabolic changes. Intestinal diseases, post-gastrectomy state, pancreatic insufficiency, inflammatory colon diseases, Crohn’s disease and ulcerative colitis lead to malabsorption and maldigestion. The use of certain medications for the treatment of these diseases is associated with significant bone metabolic changes. Bariatric surgery is becoming increasingly widespread in the therapy of high-grade obesity and type 2 diabetes mellitus. It also contributes significantly to bone loss. Osteoporosis can be an independent signal for gastroenterological diseases in asymptomatic patients. Its incidence varies from 13% to 50% in different populations with inflammatory intestinal diseases. Patients with intestinal diseases have impaired calcium and vitamin D absorption, which alters their bone health and increases the relative fracture risk up to 1.4. After gastrectomy, 32-42% of the patients have low bone density, those with Crohn’s disease in 22-55% have osteopenia and in 3-6% osteoporosis. The diet regimen and the control of the activity of inflammatory gastrointestinal diseases are key in the therapy combined with appropriate anti-osteoporosis treatment.
Key words: bone, gastrointestinal diseases, osteoporosis, бариатрична хирургия, bariatric surgery
