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Gut–Bone Interactions and Implications for the Child With Chronic Gastrointestinal Disease

Klein, Gordon L.

Journal of Pediatric Gastroenterology & Nutrition: September 2011 - Volume 53 - Issue 3 - p 250–254
doi: 10.1097/MPG.0b013e3182254828
Invited Review

ABSTRACT: Bone is not simply a framework on which to hang viscera and connective tissue; it is also a dynamic interactive organ system with roles in immunoregulation, adipogenesis, and vascular calcification, among others. Bone is intimately affected by chronic disease, including gastrointestinal disease. The mechanisms for bone loss in conditions such as inflammatory bowel disease, celiac disease, and cystic fibrosis are discussed with regard to the role of the inflammatory response. Furthermore, we raise the issue of effects of inflammation on both intestinal and renal calcium and phosphate transport, although the ways in which these actions affect bone are not explained and require further research. The stress response, a prominent feature following burn injury, is also elucidated and its relation to gastrointestinal disease is examined. We then discuss the importance of knowing the mechanism of bone loss to determine proper prevention and treatment for the bone loss in specific gastrointestinal conditions.

Department of Orthopaedic Surgery and Rehabilitation and, Shriners Burns Hospital, University of Texas Medical Branch, Galveston.

Address correspondence and reprint requests to Gordon L. Klein, MD, MPH, AGAF, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0165 (e-mail:

Received 27 December, 2010

Accepted 11 May, 2011

The authors report no conflicts of interest.

Copyright 2011 by ESPGHAN and NASPGHAN