What is the connection between erosive gastropathy and osteoporosis in a young adult?

Connection Between Erosive Gastropathy and Osteoporosis in Young Adults

Young adults with erosive gastropathy are at increased risk for developing osteoporosis due to malabsorption of nutrients essential for bone health, chronic inflammation, and potential medication side effects. 1, 2

Pathophysiological Connections

• Erosive gastropathy can impair absorption of calcium and vitamin D, which are essential nutrients for bone health and maintenance 2, 3
• Chronic inflammation from gastric erosions may contribute to bone loss through inflammatory cytokines that affect bone remodeling 1
• In young adults (under 50 years), bone mineral density (BMD) should be evaluated using Z-scores rather than T-scores, with a Z-score ≤ -2.0 considered abnormal and requiring further evaluation 1, 4
• Malnutrition and low body weight associated with gastrointestinal disorders are significant risk factors for developing osteoporosis 1

Medication-Related Factors

• NSAIDs and salicylates, commonly associated with erosive gastropathy (found in 46% of cases), can negatively impact bone health through various mechanisms 5
• Proton pump inhibitors (PPIs), often used to treat erosive gastropathy, may contribute to osteoporosis when used chronically by creating a state of achlorhydria that impairs calcium absorption 6
• If PPIs are necessary for management, calcium supplementation should be considered to ensure adequate daily intake of 1500 mg 1

Assessment Recommendations for 23-Year-Olds

• For premenopausal women and men younger than 50 years with gastrointestinal disorders, BMD evaluation using Z-scores is recommended, particularly if they have risk factors 1
• A Z-score of -2.0 or lower is considered "below the expected range for age" and requires further evaluation to exclude causes of low BMD 1
• The International Osteoporosis Foundation defines osteoporosis in young adults as a T-score lower than -2.5 at the lumbar spine or hip in association with a chronic disease known to have adverse effects on bone metabolism 1

Specific Considerations for Young Adults

• Young adults with gastrointestinal diseases may not achieve optimal peak bone mass due to nutritional deficiencies and inflammation, setting the stage for future osteoporosis 2, 6
• Body weight history requires careful assessment; a history of low weight or eating disorders may impair achievement of genetically determined peak bone mass 1
• The relationship between BMD and fracture risk in young eugonadal individuals is not well defined due to insufficient prospective data 1

Management Approach

• Ensure adequate calcium intake (1500 mg daily) through diet or supplements 1
• Assess and correct vitamin D deficiency 1
• Encourage regular weight-bearing exercise 1
• Avoid smoking and excessive alcohol consumption 1
• Consider referral to an osteoporosis specialist if BMD is unexpectedly low or if there are unusual features of osteoporosis at a young age 1

Important Caveats

• Currently, there are no registered drugs with proven antifracture activity specifically for premenopausal young women and young men with secondary osteoporosis 6
• BMD measured by DXA can result in overestimation in taller individuals and underestimation in petite individuals 1
• Fracture risk assessment tools like FRAX are not validated for those younger than 40 years 1
• If vertebral fractures are present, this indicates high fracture risk regardless of age 1