Gastroenterology

Gastroenterology

Volume 124, Issue 3, March 2003, Pages 791-794
Gastroenterology

American Gastroenterological Association medical position statement: Guidelines on osteoporosis in gastrointestinal diseases, This document presents the official recommendations of the American Gastroenterological Association (AGA) Committee on Osteoporosis in Gastrointestinal Disease. It was approved by the Clinical Practice Committee on September 21, 2002, and by the AGA Governing Board on November 1, 2002.

https://doi.org/10.1053/gast.2003.50107Get rights and content

Abstract

Osteoporosis is increasingly recognized as a source of significant disability, an awareness that has prompted clinicians to actively pursue the diagnosis among high-risk patients. Fractures have an obvious associated morbidity, a negative impact on quality of life, and both direct and indirect costs. Much of the available clinical information regarding osteoporosis screening, outcomes, and therapeutic interventions is derived from the postmenopausal osteoporosis literature. This position statement summarizes the graded findings and recommendations of a systematic technical review of osteoporosis in 3 common digestive disorders: inflammatory bowel disease (IBD), celiac disease, and postgastrectomy states.

GASTROENTEROLOGY 2003;124:791-794

Section snippets

Summary of bone disease in inflammatory bowel disease

  • Osteomalacia and vitamin D deficiency are not common in IBD (including Crohn's disease) and are unlikely to be important causes of most cases of diminished bone mineral density (BMD) in IBD (level B evidence).

  • IBD has only a modest effect on BMD, with a pooled Z score of −0.5 (level A evidence).

  • The overall prevalence of osteoporosis (T score <−2.5) using DXA is approximately 15%, but is strongly affected by age, being higher in older subjects (level A evidence).

  • At diagnosis, the prevalence of

Summary of bone disease in celiac disease

  • Osteoporosis is more common in patients with untreated celiac disease than in the general population (level A evidence).

  • Vitamin D deficiency is common in celiac disease, but the actual prevalence of osteomalacia in celiac disease is unknown (level B evidence).

  • Among newly diagnosed patients, the prevalence of osteoporosis using DXA is approximately 28% at the spine and 15% at the hip (level B evidence).

  • In adults with a known diagnosis of celiac disease treated with a gluten-free diet, the

Summary of bone disease in postgastrectomy states

  • Postgastrectomy patients typically have a number of risk factors for osteoporosis, and bone disease may not necessarily be a sequela of the surgery per se. Nonetheless, postgastrectomy patients are at risk for bone disease (level A evidence).

  • Osteoporosis and osteomalacia may both occur postgastrectomy. The incidence of osteomalacia is approximately 10%–20% (level B evidence). The incidence of osteoporosis is unknown but may be as high as 32%–42% (level B evidence).

  • Postgastrectomy states are

Management

There is a paucity of therapeutic intervention studies specifically aimed at bone health in GI diseases. Most therapy studies of sufficient size are in populations of postmenopausal women or corticosteroid-using patients who do not have GI disease. There is a need for studies that assess interventions directed at improving bone health in patients with GI disease specifically and that use fracture prevention as endpoints.

The following steps outline a possible approach to managing osteoporosis in

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Address requests for reprints to: Chair, Clinical Practice Committee, AGA National Office, c/o Membership Department, 4930 Del Ray Avenue, Bethesda, Maryland 20814. Fax: (301) 654-5920.

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