Metabolic bone disease (MBD) is present in up to 50% of patients at the time of initiation of parenteral nutrition (PN) and commonly develops after initiation of PN, resulting in a prevalence of about 80% in patients affected by short bowel syndrome (SBS) requiring PN. The lifelong process of bone development and bone homeostasis is coupled with repair and maintenance and depends on the interplay of osteoblasts and osteoclasts, while being coordinated by hormonal and paracrine signaling pathways. Genetic, mechano-response-related, endocrine-metabolic, and nutritional determinants impact bone homeostasis. In this chapter, we review the components of the key pathways in bone health among the bone, intestine, and kidneys and follow this with a discussion of the approach to diagnosing and managing MBD in the context of the adult patient with SBS [1-3]. This chapter concludes with a brief synopsis of our suggested approach to the maintenance of bone health in SBS.
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