Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
Center for Nutrition and Bowel Disease, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Denmark.
Clin Nutr. 2018 Oct;37(5):1654-1660. doi: 10.1016/j.clnu.2017.07.018. Epub 2017 Aug 5.
BACKGROUND & AIMS: Intestinal insufficiency and intestinal failure are associated with malabsorption of micro- and macronutrients that may negatively influence bone metabolism and increase the risk for developing osteoporosis. However, information regarding prevalence and contribution of individual risk factors is scarce. We investigated the prevalence of osteoporosis in patients with intestinal insufficiency and intestinal failure and identified associated risk factors.
This was a retrospective cross-sectional study including 167 clinically stable outpatients with intestinal insufficiency or intestinal failure. Bone mineral density (BMD) was measured by dual X-ray absorptiometry and the prevalence of osteoporosis was compared to a gender and age matched population. Several clinical and demographic parameters, including body mass index (BMI), vitamin-D, smoking habits and medications, were analyzed for association with BMD.
The prevalence of osteoporosis was 56.9% in the combined patient group compared to 24.1% in the control group (OR 4.2 [95% CI, 2.3 to 7.7]; p < 0.001). BMD in the hip was independently associated with BMI (0.13 [95% CI, 0.09 to 0.18]; p < 0.001) and vitamin-D levels (-0.41 [95% CI, -0.76 to -0.06]; p = 0.03). Similar associations were seen for BMD in the spine (0.15 [95% CI, 0.08 - 0.22]; p < 0.001) and (-0.60 [95% CI, -0.76 to -0.06]; p = 0.02), respectively. Trends for low BMD were observed in smokers, and in patients using glucocorticoids, opioids, and proton pump inhibitors.
Patients with intestinal insufficiency and intestinal failure are at immense risk of developing osteoporosis. Low BMI and vitamin-D deficiency were identified as independent risk factors.
肠吸收不良和肠衰竭与微量和常量营养素的吸收不良有关，这可能会对骨骼代谢产生负面影响，并增加骨质疏松症的发病风险。然而，关于个体危险因素的患病率和贡献的信息很少。我们调查了肠吸收不良和肠衰竭患者中骨质疏松症的患病率，并确定了相关的危险因素。
这是一项回顾性的横断面研究，纳入了 167 例临床稳定的肠吸收不良或肠衰竭门诊患者。采用双能 X 线吸收法测量骨矿物质密度（BMD），并将骨质疏松症的患病率与性别和年龄匹配的人群进行比较。分析了包括体重指数（BMI）、维生素 D、吸烟习惯和药物在内的多个临床和人口统计学参数与 BMD 的相关性。
在合并患者组中，骨质疏松症的患病率为 56.9%，而对照组为 24.1%（OR 4.2 [95%CI，2.3 至 7.7]；p<0.001）。髋部 BMD 与 BMI（0.13 [95%CI，0.09 至 0.18]；p<0.001）和维生素 D 水平（-0.41 [95%CI，-0.76 至-0.06]；p=0.03）独立相关。脊柱 BMD （0.15 [95%CI，0.08 至 0.22]；p<0.001）和 BMD （-0.60 [95%CI，-0.76 至-0.06]；p=0.02）也存在类似的相关性。吸烟者和使用糖皮质激素、阿片类药物和质子泵抑制剂的患者中，BMD 低的趋势更为明显。
肠吸收不良和肠衰竭患者存在发生骨质疏松症的巨大风险。低 BMI 和维生素 D 缺乏被确定为独立的危险因素。
