Endocrine Abstracts

Short bowel syndrome (SBS) is a complex disease, occurring after extensive resection of the small intestine, leading to malabsorption of nutrients and fluids. Lipids storage significantly affects bone maintenance. Caloric restriction promotes bone and adipose tissue (AT) loss but marrow adipose tissue (MAT) expansion. SBS is a condition strongly associated with malnutrition; patient survival initially depends of caloric replacement through parenteral nutrition (PN). The present study was designed to prospectively evaluate the association of subcutaneous (SAT), visceral (VAT), intra-hepatic lipids (IHLs) and MAT on bone mineral density (BMD) in SBS patients. Also, it was investigated the relationship between adipose tissue and bone markers [osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTX)]. The study comprised two groups matched by age, sex and height: a) control group (CG) (n=18; 9M, 9F) and b) SBS group that was evaluated two times, (SBS0; n=14; 7M,7F) at 6.5 years after enterectomy and 1 year latter (SBS1; n=11; 6M, 5F). Magnetic resonance was used to measure AT (¹H spectroscopy for MAT). SBS group showed a non-significant decrease in BMD throughout the study, but BMD was lower in SBSG0 and SBS1 than in CG. IHLs were higher in SBS0 and SBS1 than in CG. CTX was lower in SIC0 comparing to CG (CG=0.36±0.19×SIC0=0.81±0.57). Values of MAT, SAT, VAT and OC were similar between groups throughout the study. MAT was negatively correlated with L3 BMD in the CG (r=-0.6; P<0.05), but not in the SBS group (SBS0 r=0.45; P=0.13; and SBS1 r=0.45; P=0.17). After adjustments by body mass index (BMI) and age, the association disappeared (R²=0.09; P=0.91). IHL was negatively and significantly associated with femoral neck BMD (R²=0.16; P<0.05) and total hip BMD (R²=0.27; P<0.05). Moreover, IHL was positively and significantly associated with CTX (R²=0.46; P<0.05). There was no association between MAT and CTX. Osteoporosis is a frequent complication in SBS patients. MAT amount is not increased and there is no negative relationship between MAT and BMD in SBS. Access to calories seems to positively affect the relationship between MAT and bone mass in malnutrition. The accumulation of IHLs negatively affects bone mass in SBS patients.