UEG press release
Gastrointestinal disorders are being overlooked as risk factors for osteoporosis in many guidelines
(Vienna, 8 May 2012) Mounting evidence linking the gastrointestinal (GI) tract with the development of osteoporosis has led to calls for gastroenterologists to get more involved in the fight against osteoporosis and for GI risk factors to featuremore prominently in European osteoporosis prevention guidelines. Professor Heidi-Ingrid Maaroos, from the University of Tartu in Estonia, speaking on behalf of the United European Gastroenterology (UEG), says: “Much more needs to be done to raise awareness of the role of GI disorders and certain commonly used treatments in the development of osteoporosis. Gastroenterologists must join forces with family doctors and other specialists to try and prevent osteoporosis, which has now reached epidemic proportions and is increasingly affecting younger people.”
The osteoporosis epidemic
Osteoporosis has become a major public health issue throughout the world, with an estimated 1.6 million fractures per year attributed to the condition. The European Parliament Osteoporosis Interest Group, working with the International Osteoporosis Foundation and the European Union (EU) Osteoporosis Consultation Panel has led the way in studying the epidemiology, pathogenesis and clinical management of osteoporosis, culminating in the development of recommendations and national guidelines for improving the treatment and prevention of the condition throughout the EU. Unfortunately, says Professor Maaroos, although this is a remarkable achievement, many of the guidelines do not address GI risk factors, thereby overlooking important – and potentially preventable – causes of osteoporosis.
“A healthy GI tract is essential for absorbing nutrients, including vitamins and minerals, that are critical for bone formation and bone health,” she says. “There is now compelling evidence that certain GI conditions and some commonly used treatments alter gastric function to such an extent that bone health is affected.”
Osteoporosis and the GI tract
Osteoporosis can develop as a result of alabsorption of nutrients or maldigestion in conditions such as coeliac disease or atrophic gastritis, or as a secondary effect of treatments including gastric bypass surgery, corticosteroids and proton pump inhibitors (PPIs). In coeliac disease, which is one of the most common under-diagnosed geneticbased conditions affecting humankind, up to 75% of newly diagnosed adults have significantly reduced bone mineral density at the time of diagnosis.
“People with coeliac disease have problems absorbing nutrients such as calcium from their diet, and many will have also avoided calcium-rich milk products for years because of 2 their lactose intolerance,” Prof. Maaroos explains. “This significantly compromises bone health and doubles the risk of bone fracture compared with the general population.” Low gastric acidity, which is evident with atrophic gastritis and after the use of PPIs, can also lead to malabsorption of vitamins and minerals, increasing the risk of osteoporotic bone fractures. Concerns over the risk of osteoporosis associated with long-term use of PPIs have led to recommendations that PPIs are used only for appropriate indications such as gastro-oesophageal reflux disease (GORD), peptic ulcer disease and treatment of Helicobacter pylori (H. pylori), with doses being no higher or treatment being taken for no longer than is necessary to achieve the desired results.
Steroids are used as a first-line treatment for inflammatory bowel disease (IBD), and are another cause for concern, as they can also lead to nutritional problems and low bone mineral density. “This is a particularly worrying issue as so many young people take these medications to manage their IBD,” says Prof. Maaroos.
Gastric bypass (or bariatric) surgery, which is increasingly being used as a treatment for obesity, is also associated with malabsorption of minerals, potentially putting patients at risk of developing osteoporosis.
Putting GI disease on the osteoporosis agenda
Prof. Maaroos believes that gastroenterologists and other clinicians can help to prevent osteoporosis by keeping in mind the risks associated with bariatric surgery and “silent conditions” such as coeliac disease and atrophic gastritis, and by appropriate use of steroids and PPIs, with monitoring of bone mineral density where needed. “We would also like to see these GI risk factors feature far more prominently in European and national guidelines for the prevention of osteoporosis,” she says.
UEG – United European Gastroenterology – www.ueg.eu
Celebrating 20 years of the UEG
This year, the UEG is proud to be celebrating the 20th anniversary of its foundation and the first United European Gastroenterology Week (UEG Week), which was held in Athens in 1992. Much has been accomplished since then, and today, the UEG is the most comprehensive organisation of its kind in the world, representing over 22,000 European specialists with an interest in diseases of the digestive system.
To learn more about the UEG and our work, please visit: www.ueg.eu
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