Metabolic Bone Disease in Gastrointestinal Disorders

In the context of gastrointestinal disorders, metabolic bone disease can be broadly divided into osteoporosis and osteomalacia. This chapter focuses on metabolic bone disease associated with chronic liver disease, inflammatory bowel disease, celiac disease, and drug‐associated metabolic bone disease, specifically reviewing glucocorticoid (GC)‐induced osteoporosis and the link between proton pump inhibitors and osteoporotic fractures. Bone loss in hepatic osteodystrophy was initially hypothesized to be caused by impaired absorption and metabolism of vitamin D. Oral glucocorticoids are commonly prescribed for the treatment of inflammatory bowel disease (IBD) and act as an important immunosuppressive agent. Proton pump inhibitors are one of the most highly prescribed therapies and are used to treat multiple gastrointestinal disorders including heartburn symptoms, gastroesophageal reflux disease, and peptic ulcer disease. The use of corticosteroid therapy in both IBD and chronic liver disease is a significant risk factor, the effect of which is intrinsically linked with disease activity.