Thursday, August 17, 2017

Inflammatory bowel disease

If you have a chronic intestinal problem, such as ulcerative colitis
or Crohn’s disease, your risk for developing osteoporosis is
threefold:

The part of your intestine that absorbs vitamin D may be damaged
by inflammation, and therefore you become vitamin D
deficient.

You may have had surgery, which removed the part of your
intestine that absorbs vitamin D.

You may be taking medications, such as corticosteroids,
which increase bone loss. (See the section “Why corticosteroids
can thin bones” earlier in this chapter.)
Your bone density may improve if your disease is in remission and
you’re no longer taking corticosteroids.

Bone loss after stomach surgery

New studies have shown that many people lose bone faster than
they can replace it in the months following bariatric surgery to
induce weight loss. Those people who lose the most weight and
those people who lose weight quickly are most at risk, with up to
an 8 percent drop in bone density six months after surgery. This
loss may be the result of less efficient absorption of calcium, to
the weight loss itself, or to the fact that vitamin D isn’t adequately
absorbed if part of the small intestine is removed.

Some people develop osteomalacia, a defect in the body’s ability to
mineralize bone, after stomach surgery. Osteomalacia (see Chapter
1 for more info) is considered to be “adult rickets” and results in
many fractures in unusual places (ribs, pelvic bones, and shoulder
blades).

Differentiating between osteoporosis and osteomalacia is important
because treatment may differ. Your doctor can perform a bone
biopsy to determine which condition is present. Bone biopsies are
simple procedures to perform, but pathologists with special training
in bone diseases need to interpret the results so that you
receive the proper treatment.

Celiac disease and bone loss

As many as 1 in 250 men and women have an inherited disease
called celiac disease, or nontropical sprue. People with celiac disease
don’t absorb adequate nutrients through the small intestine
because their intestinal lining is damaged by eaten gluten, which
is found in wheat.

Severe celiac disease can be associated with marked deficiency of
vitamin D and numerous fractures. Patients without obvious causes
of osteoporosis need to be screened for celiac disease because it’s
fairly common. Your doctor can diagnose celiac disease with a combination
of history, blood tests, and intestinal biopsies. All untreated
patients need to have frequent bone density testing and vitamin D
measurements.

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