Decreased bone mineral density in adults with type 2 intestinal failure: A descriptive cross-sectional study

Metabolic bone disease, which includes osteopenia and osteoporosis, is a recognized complication of chronic intestinal failure, occurring in up to 67% of patients, such that international guidelines recommend screening every 12-18 months for those on home parenteral nutrition. However, data on the prevalence and risk factors for metabolic bone disease in acute type 2 intestinal failure are lacking.

This was a descriptive cross-sectional study on adults with type 2 intestinal failure admitted to a national UK Intestinal Failure Reference Center between July 1, 2018 and April 30, 2023. Collected variables included demographics, clinical characteristics, medications, laboratory results and bone mineral density measured using dual-energy X-ray absorptiometry.

A total of 150 patients were included in the analysis. Mechanisms of intestinal failure included short bowel syndrome (57.4%), intestinal fistula (30.0%), and dysmotility (8.0%). Osteopenia was identified in 46.0% and osteoporosis in 15.3% of patients. Multivariable analysis identified dysmotility and prolonged steroid use as being independently associated with decreased bone mineral density, whereas calcium supplementation and higher body mass index were associated with increased bone mineral density.

Metabolic bone disease is prevalent among patients with type 2 intestinal failure. In addition to established risk factors, gastrointestinal dysmotility, often diagnosed late, is independently associated with lower bone mineral density. These findings support the consideration of routine baseline assessment of bone mineral density at the point of presentation with type 2 intestinal failure, with a potential need now to review existing guidelines which focus primarily on monitoring in type 3 intestinal failure.