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.☆
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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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