Abstract

BACKGROUND:

Patients undergoing intestinal urinary diversion (IUD) may have a higher risk of osteoporosis and risk of fractures due to metabolic acidosis and decrease of intestinal absorption surface.

OBJECTIVE:

We performed a systematic review of the available literature on the impact of IUD on bone demineralization.

METHODS:

We systematically searched PubMed^®, for original articles published before April 2020. Primary end points were the risk of fracture and loss of bone density. Secondary outcomes were the metabolic changes in biochemical and urine parameters related to calcium metabolism and histological changes.

RESULTS:

Our electronic search identified a total of 2417 articles. After a detailed review, we selected 11 studies that addressed the impact of IUD on bone health in 10369 patients. The risk of bone fracture was studied in 3 articles, showing a higher risk in the IUD population. Of the 9 articles evaluating the relation between intestinal urinary diversion and bone density, 5 did find a positive association. One article evaluated the bone metabolism at a cellular level after UID showing a decrease in bone turnover in this population. Three of the eight studies reporting data on serum parameters related to calcium and phosphate metabolism showed differences. Finally, a correlation between concentration of pyridolines in urine and loss of bone density was found in two of the three studies.

CONCLUSIONS:

Although published data on BMD are contradictory, patients undergoing IUD seem to be at higher risk of bone fractures. Our finding support the need to implement accessible strategies on osteoporosis screening and prevention in IUD patients.

中文翻译：

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肠尿改道对骨折和骨质流失风险的影响：系统评价

 抽象的

 背景：

接受肠道尿流改道（IUD）的患者可能因代谢性酸中毒和肠道吸收表面积减少而出现骨质疏松和骨折的风险较高。

 客观的：

我们对有关宫内节育器对骨脱矿影响的现有文献进行了系统回顾。

 方法：

我们系统地搜索了 PubMed ^® ，查找 2020 年 4 月之前发表的原始文章。主要终点是骨折和骨密度损失的风险。次要结果是与钙代谢和组织学变化相关的生化和尿液参数的代谢变化。

 结果：

我们的电子检索共找到 2417 篇文章。经过详细审查后，我们选择了 11 项研究，探讨了宫内节育器对 10369 名患者骨骼健康的影响。 3 篇文章对骨折风险进行了研究，显示宫内节育器人群的骨折风险较高。在评估肠道尿流改道与骨密度之间关系的 9 篇文章中，有 5 篇确实发现了正相关关系。一篇文章在 UID 后在细胞水平上评估了骨代谢，显示该人群的骨转换减少。报告与钙和磷酸盐代谢相关的血清参数数据的八项研究中的三项显示出差异。最后，三项研究中的两项发现尿液中吡啶啉浓度与骨密度损失之间存在相关性。

 结论：

尽管已发表的 BMD 数据相互矛盾，但接受宫内节育器的患者骨折的风险似乎更高。我们的发现支持需要对宫内节育器患者实施骨质疏松症筛查和预防的可行策略。