Krela-Kaźmierczak Iwona, Szymczak Aleksandra, Łykowska-Szuber Liliana, Eder Piotr, Linke Krzysztof
Department of Gastroenterology, Human Nutrition and Internal Diseases, Poznan University of Medical Sciences, Poland.
Adv Clin Exp Med. 2016 Jan-Feb;25(1):185-90. doi: 10.17219/acem/33746.
Secondary osteoporosis occurs as an isolated pathology or co-exists with types I and II osteoporosis. The gastroenterologist may come across osteoporosis or osteopenia in a patient with a gastrointestinal disease. This is often a young patient in whom investigations should be carried out and appropriate treatment initiated, aimed at preventing bone fractures and the formation of the best peak bone mass. Osteoporosis occurs in patients with the following conditions: Crohn's disease, ulcerative colitis, celiac disease, post gastrectomy patients, patients with short bowel syndrome, chronic hepatitis and cirrhosis, treated with steroids (steroid-induced osteoporosis) and patients using proton pump inhibitors chronically (state of achlorhydria). It is therefore necessary to approve a list of risk factors of secondary osteoporosis, the presence of which would be an indication for screening for osteoporosis, including a DXA study and the development of a separate algorithm for the therapeutic management of secondary osteoporosis accompanying gastrointestinal diseases, especially in premenopausal young women and young men, because there are currently no registered drugs with proven antifracture activity for this group of patients.
继发性骨质疏松症可作为一种独立的病症出现,或与I型和II型骨质疏松症并存。胃肠病学家可能会在患有胃肠道疾病的患者中发现骨质疏松症或骨质减少。这类患者通常较为年轻,应进行相关检查并启动适当治疗,目的是预防骨折并形成最佳的峰值骨量。以下情况的患者会发生骨质疏松症:克罗恩病、溃疡性结肠炎、乳糜泻、胃切除术后患者、短肠综合征患者、慢性肝炎和肝硬化患者、接受类固醇治疗者(类固醇诱导的骨质疏松症)以及长期使用质子泵抑制剂者(胃酸缺乏状态)。因此,有必要认可继发性骨质疏松症的危险因素清单,其存在将作为骨质疏松症筛查的指征,包括进行双能X线吸收测定(DXA)研究,并制定一套针对伴随胃肠道疾病的继发性骨质疏松症治疗管理的单独算法,尤其是针对绝经前年轻女性,因为目前尚无已注册的、对该组患者具有经证实的抗骨折活性的药物。