Prevalence Of Metabolic Bone Disease Research Articles

Overweight and abdominal fat are associated with normal bone mineral density in patients with ulcerative colitis.

BACKGROUNDLow bone mineral density (BMD) is common in patients with inflammatory bowel disease. However, nutritional risk factors for low BMD in the ulcerative colitis (UC) population are still poorly understood.AIMTo investigate the association of anthropometric indicators and body composition with BMD in patients with UC.METHODSThis is a cross-sectional study on adult UC patients of both genders who were followed on an outpatient basis. A control group consisting of healthy volunteers, family members, and close people was also included. The nutritional indicators evaluated were body mass index (BMI), total body mass (TBM), waist circumference (WC), body fat in kg (BFkg), body fat in percentage (BF%), trunk BF (TBF), and also lean mass. Body composition and BMD assessments were performed by dual-energy X-ray absorptiometry.RESULTSThe sociodemographic characteristics of patients with UC (n = 68) were similar to those of healthy volunteers (n = 66) (P > 0.05). Most patients (97.0%) were in remission of the disease, 58.8% were eutrophic, 33.8% were overweight, 39.0% had high WC, and 67.6% had excess BF%. However, mean BMI, WC, BFkg, and TBF of UC patients were lower when compared to those of the control group (P < 0.05). Reduced BMD was present in 41.2% of patients with UC (38.2% with osteopenia and 2.9% with osteoporosis) and 3.0% in the control group (P < 0.001). UC patients with low BMD had lower BMI, TBM, and BFkg values than those with normal BMD (P < 0.05). Male patients were more likely to have low BMD (prevalence ratio [PR] = 1.86; 95% confidence interval [CI]: 1.07-3.26). Those with excess weight (PR = 0.43; 95%CI: 0.19-0.97) and high WC (PR = 0.44; 95%CI: 0.21-0.94) were less likely to have low BMD.CONCLUSIONPatients with UC in remission have a high prevalence of metabolic bone diseases. Body fat appears to protect against the development of low BMD in these patients.

Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease.

Background Bone loss is common in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the prevalence of metabolic bone disease in patients newly diagnosed with IBD and to identify the risk factors for bone loss over time. Methods We performed a retrospective, both cross-sectional and longitudinal, study to extract the risk factors of bone loss (including osteopenia and osteoporosis) in patients newly diagnosed with IBD, using dual-energy X-ray absorptiometry (DXA). Results A total of 639 patients newly diagnosed with IBD that had at least one DXA were included in the cross-sectional study. Osteopenia and osteoporosis were diagnosed in 24.6% and 5.4% of patients, respectively. Age at diagnosis, body mass index, and serum phosphorus were identified as independent factors associated with bone loss at baseline. A total of 380 of the 639 IBD patients (including 212 CD patients and 168 UC patients) with at least a second DXA scan were included in the longitudinal study. 42.6% of the patients presented a worsening of bone loss in the follow-up study. Menopause, albumin, and use of corticosteroids were identified as independent factors associated with worsening of bone loss. Conclusions Metabolic bone disease is common in IBD patients, and there is a significant increase in prevalence of bone loss over time. Postmenopausal female, malnourished patients, and those requiring corticosteroid treatment are at risk for persistent bone loss. Therefore, BMD measurements and early intervention with supplementation of calcium and vitamin D are recommended in IBD patients with high-risk factors.

Higher prevalence of metabolic bone disease (MBD) but similar fracture risk in non-alcoholic fatty liver disease (NAFLD) compared to chronic viral hepatitis

Background and Aim: A link between NAFLD and MBD has been reported. However, the main implication of MBD is fracture risk which has been largely unexplored in NAFLD. Dual energy X-ray absorptiometry, the gold standard for osteopenia and osteoporosis, is an incomplete predictor of fracture risk which is substantially influenced by clinical risk factors. Fracture risk assessment tool (FRAX) is validated for prediction of 10-year risk of major osteoporotic or hip fractures. Methods: In this ongoing cross-sectional study, we aim to compare prevalence of MBD and assess fracture risk in non-cirrhotic NAFLD with chronic viral hepatitis (CVH). Exclusion criteria include age<40 years, pregnancy, evidence of cirrhosis on imaging or liver stiffness measurement (LSM) > 12 kPa, CKD, treatment with calcium, vitamin D, tenofovir or anti-osteoporotic medications, presence of skeletal deformities or refusal to give consent. MBD, osteopenia and osteoporosis are defined as T-score <-1, -1 to -2.5 and <-2.5, respectively. Fracture risk will be estimated using the Indian FRAX calculator. Results : So far, 82 NAFLD and 99 CVH have been recruited [Hepatitis B: 19 (19.2%) Hepatitis C: 80 (80.8%)] with no difference in age or gender. NAFLD patients had significantly higher BMI and higher likelihood of T2DM, hypertension and Vitamin D insufficiency. MBD (54.9% vs 29.3%, p<0.001), osteopenia (47.6% vs 28.3%, p=0.008) and osteoporosis (7.3% vs 1%, p=0.03) were significantly more common in NAFLD. NAFLD was independently associated with MBD [aOR: 1.89 (1.04-6.1, p=0.04) after adjusting for age, gender, Vitamin D, T2DM, obesity, smoking, alcohol and LSM. However, 10-year predicted major osteoporotic [1.2% (0.7 to 11.9) vs 1.1% (0.6-10.5), p=0.54] and hip fracture risk [0.15% (0 to 3.8) vs 0.1% (0 to 2.7), p=0.63] were comparable among NAFLD and CVH. Conclusions: Although, MBD is common in NAFLD, it may not portend an increased fracture risk compared to CVH.

COMPARISON BETWEEN LOW AND HIGH DOSES OF PROPHYLACTIC VITAMIN D IN PREVENTION OF OSTEOPENIA OF PREMATURITY

Osteopenia of prematurity (OOP) is a term used to describe a reduction in bone mineral content (BMC) of the preterm infant. Its incidence has been steadily increasing with the survival of more premature neonates as a result of advances in neonatal care. The prevalence of metabolic bone disease is inversely associated with birth weight and gestational age. Up to a third of infants weighing less than one kilogram at birth are osteopenic, more so if they are breastfed.To develop normally, the skeleton of the fetus requires active materno-fetal transfer of protein, Calcium (Ca) and phosphorus (P). Bone mineralization which occurs predominantly during the third trimester will be inadequate if the fetal increased demands in Ca and P are not met. During pregnancy augmented maternal intestinal absorption and increased skeletal mobilization increase maternal Ca supply to the fetus.Factors that impede normal bone mineralization include inadequate postnatal intake of vitamin D, calcium (Ca) and phosphorus (P), extended periods of total parenteral nutrition, and also as a side effect of diuretics and corticosteroids prescribed to these infants. Poor bone mineralization is associated with common neonatal conditions. These include sepsis, bronchopulmonary dysplasia, cerebral pathology, acidosis, necrotizing enterocolitis and cholestasis.Depending on the severity of the demineralization, osteopenia can remain clinically silent or, if severe, can cause bone changes in the form of rarefaction, fraying, cupping, subperiosteal new bone formation or even fractures.

Metabolic bone disease in children and adolescent patients with ulcerative colitis

ObjectiveMetabolic bone disease concerns a broad spectrum of conditions related to reduced bone density. Metabolic bone disease has been linked to chronic inflammatory diseases, such as ulcerative colitis. This study examines the prevalence of metabolic bone disease in ulcerative colitis patients and explores possible clinical predictors. MethodThe authors performed a retrospective study involving children and adolescents with confirmed ulcerative colitis between January 2013 and December 2018. Bone density was evaluated through a dual-energy X-ray absorptiometry scan of the spine and total body. Osteoporosis was defined as a bone mineral density Z-score of <−2 and osteopenia as a Z-score of between −1.0 and −2. ResultsA total of 37 patients were included in this analysis, with a mean age of 13.4±3.9 years and a mean duration of illness of 2.1±2.4 years. Using lumbar spine Z-scores and total body Z-scores, osteoporosis and osteopenia were identified by dual-energy X-ray absorptiometry scan measurements in 11 patients (29.7%) and 15 patients (40.5%), and in ten patients (27%) and 13 patients (35%), respectively. Lumbar spine Z-scores were significantly positively associated with male gender (B=2.02; p=0.0001), and negatively associated with the presence of extraintestinal manifestations (B=−1.51, p=0.009) and the use of biologics (B=−1.33, p=0.004). However, total body Z-scores were positively associated with body mass index Z-scores (B=0.26, p=0.004) and duration of illness in years (B=0.35, p=0.003). ConclusionsMetabolic bone disease is very common in this cohort of Saudi Arabian children and adolescents with ulcerative colitis and its occurrence appears to increase in female patients who suffer from extraintestinal manifestations.

Nedostatek vitaminu D a jeho zdravotní dopady

Vitamin D3 cholecalciferol is produced from its cholesterol precursors in the skin under the influence of ultraviolet calc. Its subsequent hydroxylation in the liver and kidneys leads to the formation of its most active metabolite calcitriol, which plays one of the key roles in the management of calcium phosphate metabolism. However, it also has the ability to regulate the function of a number of cells and tissues that express the vitamin D receptor. The most widespread method to evaluate the status of vitamin D in the body is to measure serum levels of its meta-bolite 25 hydroxyvitamin D - 25 (OH) D. Optimal values range between 75-125 nmoll / l. Its deficit is widespread in the human population worldwide and has a significant impact on the prevalence of metabolic bone diseases. Its deficiency may support the dysfunction of many other body systems. Ensuring optimal levels of vitamin D in the popula-tion is a challenge not only for health care and especially for government administration.

114 Opportunistic Screening of Bone Mineral Density With CT Scans in Chronic Pancreatitis

INTRODUCTION: Osteoporosis and fragility fractures have been repeatedly shown to increase morbidity, mortality and socioeconomic costs. Chronic pancreatitis (CP) has multiple shared risk factors and complications that promote an imbalance in bone mineralization and remodeling which ultimately contributes to a high prevalence of metabolic bone disease. However, in the absence of societal guidelines regarding screening, dual-energy x-ray absorptiometry (DEXA) scans are not routinely performed and are not universally covered by insurance. While DEXA scan is the gold standard to assess bone mineral density, a Computed Tomography (CT) L1 vertebral density less than 135 Hounsfield Units (HU) has been validated to diagnose osteoporosis in the general population. The aim of this proof of concept study was to determine if the CT L1 vertebral threshold of 135 HU is also valid as an opportunistic screening cut-point for osteoporosis in chronic pancreatitis patients. METHODS: We selected patients with a definitive diagnosis of CP (according to the American Pancreatic Association guidelines) who were enrolled into The Ohio State Wexner Medical Center Pancreas Disease Biobank. Basic demographic information was abstracted including age, sex, race, BMI, smoking and alcohol history. Pertinent laboratory values and imaging studies, including DEXA scans, were also obtained from these patients. Baseline L1 vertebral HU values on CT scans were determined for BMD assessment (Pickhardt et al, Annals of Internal Medicine 2013). RESULTS: Sixty-four patients with definite CP were identified, including 27 (42%) with a CT and DEXA scan. Of these, 15/27 (56%) had evidence of metabolic bone disease (z-score &lt; −1.5), including 15% with osteoporosis. Mean L1 HU value in those with osteoporosis was 106. There was a statistically significant association between osteoporosis (z score &lt; −2.5) and the CT L1 HU threshold of 135 (P = 0.025, positive likelihood ratio of 8.62, PPV 60%). The L1 HU threshold of 135 had sensitivity of 75% and specificity of 91.3% for osteoporosis and a NPV of 95.45%. CONCLUSION: CT scans performed during routine clinical care of patients with CP may be useful for opportunistic screening for osteoporosis using L1 HU attenuation, especially at a threshold of 135. Larger sample sizes of patients are needed to further develop risk stratification models in CP considering other clinical risk factors.

Doença Metabólica Óssea da Prematuridade em Recém-Nascidos de Muito Baixo Peso: Estudo Observacional Retrospetivo

Metabolic bone disease of prematurity consists in a decrease of bone matrix mineral content, in comparison with the level expected for gestational age. Screening of this condition is based on serum alkaline phosphatase and phosphate levels. The aim of this study is to evaluate the prevalence of metabolic bone disease of prematurity, to assess the aspects associated with a higher risk of this disease and to describe the growth of newborns with birth weight below 1500 g and metabolic bone disease of prematurity. Observational, retrospective, multicenter and descriptive study in three neonatal intensive care units in Portugal, from May 1st 2016 to April 30th 2017. A convenience sample of very low birthweight newborns was obtained. Demographic, clinical, and laboratory variables were described in newborns with and without metabolic bone disease of prematurity. A total of 53 newborns were included in this study: 30 males, 16 with gestational age ≤ 28 weeks. Five cases of metabolic bone disease of prematurity were diagnosed. In this group, the majority of patients was male and presented a lower gestational age and birth weight, in comparison with the group without metabolic bone disease of prematurity. The average duration of parenteral nutrition was higher in newborns with metabolic bone disease of prematurity and the calcium/phosphate ratio was lower than the recommended values. Growth was similar in both groups. No patient with metabolic bone disease of prematurity underwent physical rehabilitation. The prevalence of metabolic bone disease of prematurity was 9.43%, which is lower than what is described in the literature. However, only 50% of newborns completed the screening according to the recommendations. The main risk factors identified concur with the literature. Metabolic bone disease of prematurity is a frequent but underdiagnosed comorbidity in very low birthweight newborns. It is essential to screen newborns at risk for this condition, using biochemical markers, as well as structure nutritional interventions and physical stimulation in order to avoid short and long-term consequences of this disease.

P556 The prevalence of metabolic bone disease in patients with IBD- preliminary results from POLIBD study

P556 The prevalence of metabolic bone disease in patients with IBD- preliminary results from POLIBD study

Metabolic bone disease in patients diagnosed with inflammatory bowel disease from Spain.

Background:The objective of this study was to analyse the prevalence of metabolic bone disease (MBD) in a cohort of Southern European patients with inflammatory bowel disease (IBD) and to identify associated risk factors in this population.Methods:We conducted a retrospective, both cross-sectional and longitudinal study of MBD, assessed by dual energy X-ray absorptiometry (DXA), among patients diagnosed with IBD and previously recognized risk factors for this complication from two referral Spanish institutions.Results:A total of 612 patients (58.6% diagnosed with Crohn’s disease) were included. Mean (SD) age was 44.9 (14.7) years; 71.7% of patients received at least one tapered dosage of corticosteroids before first DXA. MBD and osteoporosis were diagnosed in 66.4% and 21.4% of patients, respectively. At baseline, male gender, menopause and ulcerative colitis were found as independent risks factors for osteoporosis, whereas age, more than three IBD-related hospitalizations and previous steroid treatment were found as independent risks factors for MBD. A total of 261 patients had at least a second DXA and were included in the longitudinal study; median follow up was 56.4 months. Logistic regression model identified menopause, ulcerative colitis and baseline lumbar DXA T-score value, but not steroid treatment, as risk factors for worsening ⩾1 SD in follow-up DXA T-score. According to guidelines, all patients under treatment with corticosteroids received calcium and vitamin D supplements.Conclusion:MBD is a frequent complication in south-European IBD patients. Routine evaluation of bone density when risk factors are present, as well as calcium plus D vitamin prophylaxis in patients under corticosteroid treatment should be recommended.

Prevalence of Metabolic Bone Disease in Tube-Fed Children Receiving Elemental Formula

Background: Previous studies suggest normal mineral status in children receiving elemental formula. However, a recent multicenter survey described 51 children who developed hypophosphatemia and bone disease while receiving elemental formula. Our aim is to determine the prevalence of metabolic bone disease in children receiving extensively hydrolyzed or amino acid-based formula. Methods: We established a retrospective cohort using an institutional database of tube-fed children. We defined a “confirmed case” as a child with biochemical and radiographic evidence of bone disease (rickets and/or low-trauma fractures). We defined a “suspected case” as a child who had biochemical evidence and/or radiographic evidence of bone disease but with incomplete data during the review period. Results: A total of 102 tube-fed children receiving elemental or semi-elemental formula were identified. The four elemental and semi-elemental formulas evaluated were Neocate®, EleCare®, Pregestimil®, and Alimentum®. Not all children had complete monitoring data performed during the review period. Of the children receiving Neocate who had monitoring data (46%), 23% developed hypophosphatemia and radiographic abnormalities (fractures or rickets), which resolved with phosphorus supplementation and/or change in the formula brand. Conclusions: We estimate that at least 11% and up to 23% of all tube-fed children receiving Neocate develop metabolic bone disease. Based upon the estimated prevalence, we recommend cautious use of this formula with monitoring for evolving bone disease in this population.

Study of Clinical Profile of Metabolic Bone Diseases in Liver Cirrhosis in Central India

Background and Aim: Metabolic bone disorders also known as hepatic osteodystrophy (HOD) are well-recognized extra hepatic complication of cirrhosis. There are very scanty data on the prevalence of metabolic bone disease in the Indian population. We aimed to determine the prevalence of metabolic bone disease in patients with liver cirrhosis and to study the factors associated with it along with impact of calcium and vitamin D on bone mineral density (BMD) in patients with liver cirrhosis. Methods: Consecutive patients with liver cirrhosis between the age group of 18–65 years presented to Department of Gastroenterology, between 1/12/2014 and 30/11/2015 were evaluated with inclusion and exclusion criteria and enrolled as study population. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and total hip. Osteopenia and osteoporosis were defined according to WHO criteria. These patients were divided into three groups—normal bone mineral density, osteopenia and osteoporosis according to T score obtained by DEXA scan. All patient diagnosed to have osteoporosis and osteopenia was re-evaluated at end of 3 months of calcium and vitamin D supplementation with follow up BMD. Results: A total of 76 patients [males 67 (88.2%, female 9 (11.8%)] with a mean age of 49.90 ± 11.35 years were enrolled in this study. Prevalence of metabolic bone disease was found to be 71% (54/76). On statistical analysis, mean duration of symptoms of liver disease, BMI, platelet count, total serum bilirubin, mean CTP and MELD score were found to be statistically different in three groups of patients. There was no significant improvement/deterioration in the BMD in the osteopenia and osteoporosis groups after treatment with vitamin D and calcium. Conclusions: Prevalence of metabolic bone disease in liver cirrhosis patients in Central India is high (71%). Malnutrition in advance liver cirrhosis is important risk factor for metabolic bone disease. The authors have none to declare.

Risk Factors for Metabolic Bone Disease in IBD

Introduction: Metabolic bone disease is a major extra-intestinal manifestation of inflammatory bowel disease (IBD), with prevalence of osteopenia and osteoporosis by densitometry being 55% and 37% for Crohn's disease (CD) patients, and 67% and 18% for ulcerative colitis (UC) patients, respectively. Age, female gender, and former smoking have been previously identified as independent risk factors. The aims of this study were to assess the prevalence of metabolic bone disease (MBD) in an IBD clinic population at a VA Center and determine whether bone loss correlated with degree of colitis and IBD treatment. Methods: A review was performed of 34 IBD patients who underwent bone mineral density (BMD) testing and colonoscopy and were seen in a tertiary VA IBD clinic within the past six months. Baseline characteristics, current IBD therapy, results of BMD and colonoscopies were collected. Osteopenia was defined as minimum T score between -1 and -2.5 and osteoporosis was identified as any T score ≤ -2.5. Detailed endoscopic and pathologic findings around the time of BMD were reviewed. Statistical analysis was performed using multivariate analysis. Results: Overall mean T score was -0.9 (median -1.0). Metabolic bone disease was present in 74% of patients, with osteoporosis in six (18%), and osteopenia in 19 (56%) patients. Patients were predominantly male (N=28, 82%) and Caucasian (N=27, 79%). The median BMI was 27.0 with a median age of 59 years. Age was the only factor that correlated with bone disease status (p=0.025) in univariate analyses. Increased number of IBD medications was associated with higher BMD scores (p=0.049). Patients on no IBD therapy had median T scores of -1.75, while those on more than two medications had a median score of -1.0. In multivariate models, increased age, female, and former smoking were all independently associated with worse bone disease. BMI, race, and alcohol consumption did not correlate with BMD results in univariate or multivariate analysis. Conclusion: Age, female gender, and former smoking were all identified as independent risk factors for MBD. While severity of colitis did not correlate with bone density studies, an increased number of IBD medications was associated with less bone loss.

Study of Hepatic Osteodystrophy in Patients with Chronic Liver Disease.

Chronic Liver Disease (CLD) is a major cause of morbidity and mortality worldwide. It involves haemodynamic and metabolic complications. Hepatic Osteodystrophy is a metabolic bone disease that may occur in individuals with chronic liver disease. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an excess mortality. It has been an under recognized and inadequately studied complication among Indian population. An early diagnosis is essential to correct reversible risk factors which predispose to bone mass loss. To assess the prevalence of metabolic bone disease and identify the risk factors associated with hepatic osteodystrophy in patients with cirrhosis. This was an observational, cross-sectional, hospital based study conducted at a medical college hospital. All patients more than 20-year-old, diagnosed with chronic liver disease/Cirrhosis were enrolled. They were subjected to haematological, biochemical investigations, evaluation of Vitamin D and other hormonal parameters. Bone Mineral Density (BMD) was estimated by Dual Energy X-ray Absorptiometry (DEXA). A total of 72 patients with mean age 50.04±11.24 years were included in the study. Amongst causes of chronic liver disease were alcoholic liver disease 22 (30.6%), CLD due to hepatitis B 24 (33.3%) and chronic hepatitis C 26 (36.1%). Twenty one (29.2%) patients had normal BMD while 51 (70.8%) had a low BMD. Out of these 51 patients, 36 (70.6%) were diagnosed of osteopenia and 15 (29.4%) others were found to have osteoporosis. Vitamin D levels and severity of liver disease had correlation with low BMD. Low BMD is highly prevalent in patients with chronic liver disease of variable aetiologies. We advocate more randomised and prospective studies to be conducted on homogeneous groups with chronic liver disease in its various stages. In view of numerous therapeutic options available both for liver disease and bone disease, it is prudent to characterize this condition in order to give these patients a better chance of survival with good quality of life.

Pelvic Bone Fractures Mimicking Bone Metastases in a Patient with Hepatitis B Virus-Associated Liver Cirrhosis and Hepatocellular Carcinoma

Pelvic Bone Fractures Mimicking Bone Metastases in a Patient with Hepatitis B Virus-Associated Liver Cirrhosis and Hepatocellular Carcinoma

Transversal study on the prevalence of Metabolic Bone Disease (MBD) and Home Parenteral Nutrition (HPN) in Spain: data from NADYA group

Patients with intestinal failure who receive HPN are at high risk of developing MBD. The origin of this bone alteration is multifactorial and depends greatly on the underlying disease for which the nutritional support is required. Data on the prevalence of this disease in our environment is lacking, so NADYA-SEMPE group has sponsored this transversal study with the aim of knowing the actual MBD prevalence. Retrospective data from 51 patients from 13 hospitals were collected. The questionnaire included demographic data as well as the most clinically relevant for MBD data. Laboratory data (calciuria, PTH, 25 -OH -vitamin D) and the results from the first and last bone densitometry were also registered. Bone mineral density had only been assessed by densitometry in 21 patients at the moment HPN was started. Bone quality is already altered before HPN in a significant percentage of cases (52%). After a mean follow up of 6 years, this percentage increases up to 81%. Due to retrospective nature of the study and the low number of subjects included it has not been possible to determine the role that HPN plays in MBD etiology. Only 35% of patients have vitamin D levels above the recommended limits and the majority of them is not on specific supplementation. HPN is associated with very high risk of MBD, therefore, management protocols that can lead to early detection of the problem as well as guiding for follow up and treatment of these patients are needed.

Prevalence of Metabolic Bone Disease among Chronic Rhinosinusitis Patients Treated with Oral Glucocorticoids

The treatment of chronic rhinosinusitis (CRS) often requires chronic or intermittent oral steroid therapy, which has the potential for adverse skeletal effects, including osteoporosis and increased risk of fragility fractures. The purpose of this study was to determine the prevalence of osteopenia/osteoporosis (OP) or low bone density (LBD) in patients with CRS with/without polyposis treated with oral glucocorticoids. Retrospective chart analysis was performed at a tertiary-care rhinology practice. Patients with CRS with/without polyposis evaluated between September 2003 and July 2008 were included if they had (1) previous history of oral steroid usage (> or =5 mg daily for at least 3 months) and (2) previous bone mineral density evaluation. A total of 197 patients were included with a mean age of 51.1 years (range, 15-79 years). The primary presenting diagnoses included CRS with polyposis in 176 cases (89.3%) and CRS without polyposis in 21 cases (10.7%). Concomitant asthma was present in 161 patients (81.7%). Overall, the prevalence of low bone mass was 38.6%. Among men >50 years of age and postmenopausal women, the prevalence of osteopenia/OP or LBD was 62.5 and 62.2%, respectively. Comparing men >50 years of age and postmenopausal women to their respective younger populations, both had a statistically higher presence of low bone mass (p < 0.0001), with an odds ratio of 10.6 (3.9-28.7) and 34.6 (7.4-161.5), respectively. There was no statistical difference in the presence of bone loss when comparing groups by gender. A multivariable analysis of common comorbidities revealed age to be the only factor associated with increased risk for OP/osteopenia or LBD. Patients with CRS with/without polyposis treated with oral steroids who underwent bone density testing were found to have a high prevalence of LBD. High index of suspicion is required to identify at-risk patients and to initiate careful evaluation and treatment to prevent additional bone-related complications.

Risk factors for metabolic bone disease in Crohnʼs disease patients

The aim was to evaluate the presence of metabolic bone disease (MBD) in patients with Crohn's disease (CD) and to identify potential etiologic factors. The case-control study included 99 patients with CD and 56 controls with a similar age and gender distribution. Both groups had dual-energy x-ray absorptionmetry and a nutritional evaluation. Single nucleotide polymorphisms at the IL1, TNF-α, LTα, and IL-6 genes were analyzed in patients only. Statistical analysis was performed using SPSS software. The prevalence of MBD was significantly higher in patients (P = 0.006). CD patients with osteoporosis were older (P < 0.005), small bowel involvement and surgical resections were more frequent (P < 0.005), they more often exhibited a penetrating or stricturing phenotype (P < 0.05), duration of disease over 15 years (P < 0.005), and body mass index (BMI) under 18.5 kg/m(2) (P < 0.01) were more often found. No association was found with steroid use. Patients with a Z-score < -2.0 more frequently had chronic active disease (P < 0.05). With regard to diet, low vitamin K intake was more frequent (P = 0.03) and intake of total, monounsaturated, and polyunsaturated fat was higher in patients with Z-score < -2.0 (P < 0.05). With respect to genetics, carriage of the polymorphic allele for LTα252 A/G was associated with a higher risk of osteoporosis (P = 0.02). Regression analysis showed that age over 40 years, chronic active disease, and previous colonic resections were independently associated with the risk of developing MBD. The prevalence of MBD was significantly higher in CD patients. Besides the usual risk factors, we observed that factors related to chronic active and long-lasting disease increased the risk of MBD.

Prevalence of Metabolic Bone Disease in Children With Celiac Disease Is Independent of Symptoms at Diagnosis

: Given dietary gluten exposure, growing children with celiac disease may experience malabsorption of nutrients, negatively affecting bone health. The purpose of this study was to determine the prevalence of low bone mass in children with celiac disease, according to the presence of symptoms at diagnosis. : A retrospective chart review of the Stollery Children's Hospital Celiac Clinic charts (April 1989-September 2007) was conducted. Bone mineral density (BMD) of the spine was measured using dual energy x-ray absorptiometry. Demographics, symptoms at presentation, and anthropometric and biochemical data relevant to bone health were recorded. : Seventy-four children (9.6 +/- 3.7 years; range 3.3-16.0 years) were included. Lumbar BMD z scores more than or equal to -1 were observed in 58 cases (65%), z scores below -1 but above -2 were observed in 14 cases (19%) and z scores less than or equal to -2 were observed in 12 cases (16%). There was no significant difference in mean lumbar BMD z scores between symptomatic and asymptomatic children (P = 0.34). When adjusted for bone age and bone surface area, BMD lumbar z score was inversely correlated with age at diagnosis (P < 0.05). : An equivalent reduction in spine bone mass was observed in children with celiac disease at diagnosis regardless of the presence of symptoms. Delayed diagnosis of children with celiac disease may increase the risk of adult osteoporosis. Appropriate screening of children at risk of celiac disease for the purpose of early diagnosis, as well as routine evaluation of bone mineral density in such children, are important to prevent long-term complications associated with poor bone health.

Calcium Intake and Metabolic Bone Disease after Eight Years of Roux-en-Y Gastric Bypass

Roux-en-Y gastric bypass (RYGBP) has been found to be the most efficient way to lose weight and maintain the weight loss in morbid obesity. However, with the formation of a new stomach and the modification of intestinal anatomy, there are significant changes on physiological properties of these organs that lead to nutrient deficiency, including calcium. The objectives of this study were to evaluate calcium intake, bone metabolism, and prevalence of metabolic bone disease in women subjected to RYGBP after 8 years. Food frequency questionnaire and 3-day dietary recall, laboratory tests of bone metabolism and bone mineral density were accessed. Calcium intake was below the recommendation in all women. Serum PTH and alkaline phosphatase were elevated, whereas vitamin D and urinary calcium were significantly lower. Also, a higher prevalence of metabolic bone disease than the one expected for the normal population at the same age was noted. These data suggest that metabolic bone disease could be a complication of this type of surgery.