SECONDARY OSTEOPOROSIS IN DISEASES OF THE GASTROINTESTINAL TRACT. REVIEW
Introduction. Osteoporosis (OP) is a systemic metabolic disease of the skeleton, characterized by a decrease in bone mass per unit volume with a violation of bone microarchitectonics, leading to increased bone fragility and the risk of fractures. Currently, OP is one of the urgent problems in diseases of the gastrointestinal tract (GIT), which is primarily due to the high frequency of bone metabolism disorders in such patients. Secondary OP is practically found in all diseases of the digestive system, hepatobiliary system and inflammatory bowel diseases (IBD), such as non-ulcerative colitis (NUC), Crohn's disease (CD).
Objective: study of literature on secondary OP in diseases of the gastrointestinal tract, hepatobiliary system and IBD.
Methods: We have reviewed studies, systematic reviews (CO) and meta-analyses (MA) published from 2016 to the present in the database Medline, PubMed, Cochrane, GoogleScholar, CrossRef in English. Inclusion criteria: questions on the topic of secondary OP in diseases of the digestive system, hepatobiliary system: primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ABP), liver transplantation, gallstone disease (GI), postcholecystectomy syndrome (PES), chronic pancreatitis (CP). With IBD: NUC, Crohn's disease (CD). A total of 315 sources were found, 50 sources were selected for further analysis. Exclusion criteria: repeated articles, articles without evidence, with unclear conclusions, articles published earlier than 2016 and not responding to search queries.
Results. Low bone mineral density (BMD) and OP remain common problems in patients with diseases of the gastrointestinal tract, hepatobiliary system and IBD. Thus, in chronic pancreatitis, a change in bone metabolism is associated with a violation of the absorption of vitamin D in the intestine against the background of digestive disorders in the oral cavity – digestive disorders and malabsorption develop. IBD studies indicate the role of vitamin D both in improving the outcome of the disease, and in therapy and in connection with the activity of the disease. According to a nationwide population-based cohort study in Taiwan, OP increases the subsequent risk of gallstones. In patients with various liver diseases, osteopenia and OP are also detected with age. Very often, secondary OP occurs in patients after liver transplantation. Since the loss of bone mass in the early post-transplant period occurs in almost all organ recipients and is associated with the introduction of glucocorticoids (HA), it is necessary to use minimum doses of HA and gradually reduce the dose with subsequent withdrawal of the drug. OP is a complication of cirrhosis that is not eliminated after liver transplantation, since bone loss often increases after immunosuppressant therapy. In this regard, the primary and early medical intervention in the treatment of OP in these diseases are antiresorptive drugs-bisphosphonates.
Conclusions. This article presents an analysis of secondary OP that occurs in patients with gastrointestinal tract pathology, which must be taken into account in the treatment of patients with pathology of the digestive system, hepatobiliary system and IBD, whose complication is OP.
Zulfiya M. Zhankalova1, https://orcid.org/0000-0002-5122-4130
Maral G. Nogaeva1, https://orcid.org/0000-0003-1182-5967
Moldir M. Orazbaeva1,
Gulbanu Z. Abdugulova1, https://orcid.org/0000-0001-7778-9619
Raushan N. Kasymova1, https://orcid.org/0000-0002-0845-9794
NJSC "Kazakh National Medical University named after S. D. Asfendiyarov",
Almaty c., Republic of Kazakhstan.
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Zhankalova Z.M., Nogaeva M.G., Orazbaeva M.M., Abdugulova G.Z., Kasymova R.N. Secondary osteoporosis in diseases of the gastrointestinal tract. Review // Nauka i Zdravookhranenie [Science & Healthcare]. 2021, (Vol.23) 6, pp. 178-187. doi 10.34689/SH.2021.23.6.019Related publications:
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