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Osteoporosis 4X more likely if poor gut (probably poor vitamin D absorption) – Aug 2017

Osteoporosis in patients with intestinal insufficiency and intestinal failure: Prevalence and clinical risk factors.

Clin Nutr. 2017 Aug 5. pii: S0261-5614(17)30259-5. doi: 10.1016/j.clnu.2017.07.018. [Epub ahead of print]
Nygaard L1, Skallerup A2, Olesen SS3, Køhler M2, Vinter-Jensen L4, Kruse C5, Vestergaard P5, Rasmussen HH4.

Intestinal insufficiency and intestinal failure are associated with malabsorption of micro- and macronutrients that may negatively influence bone metabolism and increase the risk for developing osteoporosis. However, information regarding prevalence and contribution of individual risk factors is scarce. We investigated the prevalence of osteoporosis in patients with intestinal insufficiency and intestinal failure and identified associated risk factors.

This was a retrospective cross-sectional study including 167 clinically stable outpatients with intestinal insufficiency or intestinal failure. Bone mineral density (BMD) was measured by dual X-ray absorptiometry and the prevalence of osteoporosis was compared to a gender and age matched population. Several clinical and demographic parameters, including body mass index (BMI), vitamin-D, smoking habits and medications, were analyzed for association with BMD.

The prevalence of osteoporosis was 56.9% in the combined patient group compared to 24.1% in the control group (OR 4.2 [95% CI, 2.3 to 7.7]; p < 0.001).

  • BMD in the hip was independently associated with BMI (0.13 [95% CI, 0.09 to 0.18]; p < 0.001) and
  • vitamin-D levels (-0.41 [95% CI, -0.76 to -0.06]; p = 0.03).

Similar associations were seen for BMD in the spine (0.15 [95% CI, 0.08 - 0.22]; p < 0.001) and (-0.60 [95% CI, -0.76 to -0.06]; p = 0.02), respectively. Trends for low BMD were observed in smokers, and in patients using glucocorticoids, opioids, and proton pump inhibitors.

Patients with intestinal insufficiency and intestinal failure are at immense risk of developing osteoporosis. Low BMI and vitamin-D deficiency were identified as independent risk factors.

PMID: 28823627 DOI: 10.1016/j.clnu.2017.07.018

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