Gastrointestinal Disease
Why do some gastrointestinal diseases increase the risk for osteoporosis?
Studies
have found an increased risk of bone loss and fractures in individuals
with certain gastrointestinal (GI) diseases. People with GI diseases
may be at increased risk for osteoporosis for many of the following
reasons.
- The inflammatory process- Natural chemicals
in the body that are related to intestinal inflammation in
inflammatory bowel disease and probably also in celiac disease are
known to increase bone breakdown.
- Malnutrition-
Malabsorption of vitamin D, calcium, possibly vitamin K and other
nutrients may contribute to bone loss in patients with GI
disease. In addition, weight loss that may occur as a result
of many GI diseases can be an important factor in reducing bone
mass. Excessive thinness is also considered an important risk factor
for hip fracture.
- Use of certain medications- Steroid medications (such as cortisone or prednisone) taken for more than three months
may be prescribed and necessary to treat GI diseases.
- Lifestyle
factors- Sometimes chronic GI conditions and or the medications
used to treat the conditions may increase fatigue and the likelihood of
inactivity. A sedentary lifestyle increases the risk for bone loss. In all populations, smoking and tobacco use increases the risk for osteoporosis and related fractures.
What gastrointestinal conditions increase the risk of low bone mineral density?
A
low bone mineral density compared to the general population has been
reported among patients with the following GI conditions:
The
likelihood of bone loss is potentially greater among elderly
individuals with the above GI conditions. In some elderly people with
GI disease, age-related bone loss along with low bone mineral density
compared to the general population, may lead to the development of
severe bone disease.
How common is osteoporosis among individuals with GI disease?
The rates of osteoporosis among individuals with the following GI diseases or conditions follow:
- Inflammatory bowel disease (Crohn's disease and ulcerative colitis)- 15%
- Newly diagnosed celiac disease- 28%
- Postgastrectomy- 32 %
What is the risk for fracture in people with GI disease?
- The risk for fracture in people with Crohn's disease and ulcerative colitis is 40% greater than in the general population.
- Individuals with celiac disease have more than a 50% greater risk for fracture than the general population.
- People who have had a gastrectromy also have an increased risk for fracture although the exact rates are not known.
How can I reduce my risk for fracture if I have GI disease?
- It is important to identify people at the highest risk for fracture. The best
predictors
for fracture among individuals with GI diseases include active
inflammatory bowel disease, long-term use of steroid medications,
history of a previous osteoporotic fracture, low bone density, and an
increased risk for falling.
- The treatment of your intestinal
disorder is the most important step to prevent bone loss and
osteoporosis. Consult with your medical professional to find out the
best way to manage your GI disease.
- If you take chronic steroid medications,
it is important to speak to your medical professional about how to best
manage your gastrointestinal disease and at the same time be on the
lowest possible dose of steroid medication for the shortest period of
time possible.
- A bone mineral density (BMD) test can diagnose osteoporosis before a fracture occurs and can help medical
professionals monitor your response to osteoporosis medications. A BMD
test is recommended for individuals who have GI disease and any of the
following risk factors:
- Men or women who are planning
to use, currently use, or have a history of using long-term steroid
medications (for more than 3 months)
- Men or women who
have a fracture or a history of fracture with minimal trauma (such as a
fracture after a fall from standing height)
- Postmenopausal women
- Men over the age of 50
- Women with low estrogen levels or men with low testosterone levels
- Adults
with celiac disease who have followed a gluten free diet for 1 year. In
most patients, a 5% increase in bone mass occurs immediately after
starting the gluten-free diet. Therefore, waiting a year will allow
bone mass to stabilize.
- Individuals who have had a gastrectomy along with any of the above risk factors
- If
your bone mass is sufficiently low or if you have a history of
fracture, speak to your medical professional to find out if an FDA-approved medication for osteoporosis is right for you.
- All
people with GI disorders including those who take
osteoporosis medication should follow the universal strategies for
healthy bones including:
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