Speakers: Peter Lakatos (Hungary), Sheila Crowe (USA)

Bone mineral disease (BMD) is common in the general population, and there is an increased risk of developing disorders of BMD – osteopenia and osteoporosis – among people with gastrointestinal (GI) disorders, especially in those with inflammatory bowel disease (IBD), untreated celiac disease, end-stage cholestatic liver disease and after gastric surgery. Dr Peter Lakatos told the audience of gastroenterologists that osteopenia and osteoporosis are present in up to one-third of patients with GI diseases (15-35%), and that these patients are at an increased risk of bone fracture, at 1.4 to 3 times that of the general population.

Dr Lakatos emphasised that it is important to identify GI patients with known risk factors for osteoporosis – these include prolonged corticosteroid use, age, postmenopausal status, prior fragility fracture, low BMI, hypogonadism, excess alcohol use – to identify those at risk early, to evaluate their bone density using dual energy X-ray absorptiometry (DXA), and to initiate early prevention or treatment strategies.

Dr Sheila Crowe discussed preventative strategies for osteoporosis, which include weight bearing exercise, adequate calcium and vitamin D intake, and avoidance of smoking and excess alcohol. She added that vitamin D deficiency is common among the general population and there is an increased risk among people with GI diseases. Approaches to the treatment of osteoporosis are two-fold: agents that decrease bone resorption and agents that increase bone formation. Anti-resorptive agents include bisphosphonates, which are approved for the treatment and prevention of postmenopausal osteoporosis and for prevention of corticosteroid induced osteoporosis; although bisphosphonates are not without side effects such as rare osteonecrosis of the jaw and subchanteric fracture. Thus, treatment holidays are recommended in long-term bisphosphonate use. New treatments that work as stimulants of bone formation include teriparatide, a recombinant form of parathyroid hormone, and denosumab which is designed to target RANK ligand, a protein that acts as the primary signal for bone removal. Dr Crowe reminded the audience that, as with many diseases, prevention is better than cure and it is important to recognise those at risk and to take preventative steps wherever possible to avoid the development of osteoporosis among those with GI disease, and resulting fragility fractures which have a high healthcare burden.