Metabolic bone disease in IBD

Abstract

A substantial number of patients with inflammatory bowel disease (IBD) will manifest extra-intestinal complications. Metabolic bone disease and arthropathies are among the most debilitating of these. Decreased bone mineral density and increased fracture risk may occur in relation to the underlying disease itself or result from vitamin, mineral, and hormonal deficiencies; medications used to treat the underlying disease; lifestyle; and perhaps other factors. In many cases, the factors remain unidentified. Options for the treating clinician include correction of these deficiencies, treatment of the underlying disease, and use of medication to promote bone formation and decrease bone resorption.

OSTEOIMMUNOLOGY: Interplay Between the Immune System and Bone Metabolism

“…Bone loss has long been recognized as an extraintestinal complication of inflammatory disorders of the gut, such as Crohn's disease and ulcerative colitis (115). One recent study found that patients with these diseases have elevated levels of serum OPG, which derive from the site of inflammation and inversely correlate with severity of bone loss (116), whereas another study found that Crohn's disease patients have elevated levels of both OPG and soluble TRANCE (117).…”

Small intestine transplantation today

“…Metabolic bone disease and arthropathies are often the most debilitating extra-intestinal manifestations of intestinal failure [32]. Osteoporosis was detected in 67% of patients with intestinal failure [33].…”

“…However, HPN has no deleterious effect on cortical bone and actually improves trabecular bone in patients whose intestinal disease started after the age of 21 years [33]. The etiology is multifactorial involving calcium and phosphate deficiency, aluminum toxicity, lack of periodic enteral feeding, malabsorption, inflammation, and drug-induced alterations in calcium and bone metabolism [32,34]. Bone metabolism disorders are more common than liver diseases, and one third of HPN patients regularly consumed analgesics or opiates [35].…”