Gut, inflammation and osteoporosis: basic and clinical concepts

Tilg, Herbert; Moschen, Alexander R.; Kaser, Arthur; Pines, Amos; Dotan, Iris

doi:10.1136/gut.2006.117382

Cited by 247 publications

(183 citation statements)

References 131 publications

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“…Osteoporosis is common in IBD occurring in 3-58% and 4-50% of patients with UC and CD, respectively (45) . Increasing age, weight loss over 10%, BMI < 20, malabsorption, poor Ca and vitamin D status, corticosteroid use and inflammation all contribute to the cause of osteoporosis (46) .…”

Section: Osteoporosismentioning

confidence: 99%

Dietary and nutritional considerations for inflammatory bowel disease

Lomer

2011

Proc. Nutr. Soc.

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Nutritional assessment and dietary advice are fundamental to inflammatory bowel disease (IBD) patient management and all patients should have access to a dietitian. Newly diagnosed patients often think that their pre-illness diet has contributed to the development of their IBD. However, epidemiological evidence to support diet as a risk factor is lacking. How the diet contributes to the gastrointestinal microbiota is interesting, although the role is not yet clearly defined. Nutritional problems in IBD are common. Malnutrition occurs in up to 85% of patients and weight loss affects up to 80% of patients with Crohn's disease and 18–62% of patients with ulcerative colitis. Nutritional deficiencies are prevalent, particularly in relation to anaemia and osteoporosis. Intestinal strictures can be problematic in Crohn's disease and limiting fibrous foods that may cause a mechanical obstruction in the gastrointestinal tract is helpful. Patients often explore dietary exclusion to alleviate symptoms but such changes may be self-directed or inappropriately advised and can lead to further nutritional deficiencies. Some patients experience concurrent functional symptoms (e.g. abdominal bloating, abdominal pain, flatulence and diarrhoea) that can significantly affect quality of life. Recently, a group of poorly absorbed carbohydrates that occur naturally in the diet called fermentable oligo-, di-, mono-saccharides and polyols have been associated with functional symptoms by intestinal bacterial fermentation leading to rapid gas production, and an osmotic effect increasing fluid delivery to the colon. Emerging evidence indicates that a diet low in fermentable oligo-, di-, mono-saccharides and polyols can alleviate functional symptoms in IBD.

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Section: Osteoporosismentioning

confidence: 99%

Dietary and nutritional considerations for inflammatory bowel disease

Lomer

2011

Proc. Nutr. Soc.

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“…Furthermore, IL-1 itself is also the strong factor which can activate the NF-κB. Therefore, IL-1 eventually increases the activation of NF-κB, and the expression of various proinflammatory mediators controlled by this factor and leads to inducement in excessive inflammatory response [21,76]. As a proof supportive of this fact, the severity of inflammatory bowel disease is not only proportional to the expression degree of IL-1 [12], but the report which claims that the symptoms can be eased through the suppress of IL-1 can be stated as a form of evidence [73].…”

Section: Proinflammatory Cytokinementioning

confidence: 99%

Inflammatory Bowel Disease and Cytokine

Choi¹,

Cho²,

Choi³

2013

Journal of Life Science

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Inflammatory bowel disease, known as Crohn's disease and ulcerative colitis, is an unexplained disease characterized by chronic inflammation that repeats a cycle of relapse, improvement, and complications. The cause of inflammatory bowel disease is not clearly known, but it is predicted that a complex of various factors precipitate its occurrence. In particular, inflammatory mediators, such as cytokine, induce an increase in cell-mediated inflammatory responses. Focal tissue damage then occurs in the intestinal mucosa because of the weakening of the immune-modulating functions of cotton. Immune and inflammatory responses do not decrease appropriately but continue until they lead to chronic inflammation. Current research has focused on the cytokine genes, which have important roles in these inflammatory responses. Cytokine is a glycoprotein that is produced mostly in activated immune cells. It connects the activation, multiplication, and differentiation between immune cells, which causes focal tissue damage and inflammatory response. Moreover, butyrate, which originates in dietary fiber and plays an important role in the structure and function of the intestinal area, shows control functions in the intestinal immune system by decreasing the proinflammatory cytokine and increasing the anti-inflammatory cytokine. Therefore, this research investigated the molecular mechanism of the anti-inflammatory effects of butyrate to comprehend the cytokine controlling abilities of butyrate in the immune cells. Butyrate is expected to have potential in new treatment strategies for inflammatory bowel disease.

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“…Inflammation, calcium and vitamin D malabsorption, sub-optimal calcium intake and secondary hyperparathyroidism have all been shown to contribute to low bone density [3]. Bone loss defects are present in >50% of untreated celiac disease patients [4].…”

Section: Introductionmentioning

confidence: 99%

A Remarkable Increase in Bone Mineral Density in Celiac Disease

Szczepanczyk¹,

Saberinia²,

Mirza³

2017

IJCD

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Introduction: Patients with active celiac disease are more likely to have osteoporosis and increased risk of fractures. Studies show that gluten-free diet may help improve bone mass to some extent. Here, we report a premenopausal woman with celiac disease with progressively declining bone mineral density (BMD) into severe osteoporosis range, who demonstrated a remarkable improvement in BMD after one year of gluten-free diet and oral bisphosphonates. Clinical case: A 44-year old premenopausal female had a low screening bone density at the ankle at 39 years of age, and was confirmed to have low BMD by central DXA, with osteoporosis at the spine and osteopenia at the hips. Celiac antibodies were positive and she was recommended gluten free diet (GFD), which she stopped after a year. Her primary care also started her on supplemental calcium and vitamin D with stabilization of BMD over the next three years. Subsequent BMD 2 years later showed 7.6% decrease in bone density at the lumbar spine (T-score -3) and 5.8% decline at the total hip (T-score -2.7) and she was referred for osteoporosis evaluation. Workup revealed high bone turnover with an elevated PTH of 162pg/mL, low normal serum calcium of 8.8mg/dL, normal vitamin D levels and low urine calcium levels, suggestive of secondary hyperparathyroidism. At this time, review of systems revealed a questionable history of gluten sensitivity, but she denied any diarrhea or bloating. A duodenal biopsy revealed villous atrophy and positive antibodies against tissue transglutaminase, compatible with active celiac disease. She was started on a gluten-free diet and alendronate was also added in view of low bone density and high bone resorption. Bone density performed one year later revealed a remarkable 14.1% increase at the level of the lumbar spine and 8.9% increase at the level of total hip compared to prior BMD. Conclusion: This is the first case of such a remarkable increase in BMD on gluten-free diet and concomitant bisphosphonate use, suggesting a cumulative benefit of this strategy that is greater than using either of these interventions alone.

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Gut, inflammation and osteoporosis: basic and clinical concepts

Cited by 247 publications

References 131 publications

Dietary and nutritional considerations for inflammatory bowel disease

Dietary and nutritional considerations for inflammatory bowel disease

Inflammatory Bowel Disease and Cytokine

A Remarkable Increase in Bone Mineral Density in Celiac Disease

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