Short-term administration of glucagon-like peptide-2. Effects on bone mineral density and markers of bone turnover in short-bowel patients with no colon.
BACKGROUND
Glucagon-like peptide 2 (GLP-2) is a newly discovered intestinotrophic hormone. We have recently reported that a 5-week GLP-2 treatment improved the intestinal absorptive capacity of short-bowel patients with no colon. Additionally, GLP-2 treatment was associated with changes in body composition that included a significant increase in total body bone mass. This article describes the effect of GLP-2 on spinal and hip bone mineral density (BMD) and biochemical markers of bone turnover in these patients.


METHODS
In an open-labelled pilot study, eight short-bowel patients (3M, 5F; mean age 49 years) with small-bowel resection and no colon received 400 microg s.c. of GLP-2 twice daily for 5 weeks. Four received home parenteral nutrition (mean length of residual jejunum 83 cm) and 4 did not (mean length of ileum resected 106 cm). The outcome measures were the mean percent change from baseline in spinal and hip BMD measured by dual-energy X-ray absorptiometry, changes in four biochemical markers of bone-turnover, PTH, 25-hydroxy vitamin-D, and the intestinal absorption of calcium.


RESULTS
Mean +/- s(x) (SEM) percent changes in spinal and hip BMD were 1.1+/-0.4% (P < 0.05) and 1.9+/-0.8% (P = 0.06), respectively. The intestinal calcium absorption increased by 2.7% (P = 0.87). Serum ionized calcium increased in 5/8 patients with a concomitant decrease in serum PTH values. Three of the four markers of bone turnover decreased.


CONCLUSIONS
A 5-week GLP-2 administration significantly increased spinal BMD in short-bowel patients with no colon. The mechanism by which GLP-2 affects bone metabolism remains unclear, but may be related to an increased mineralization of bone resulting from an improved intestinal calcium absorption.
Haderslev
K V
KV
Dept. of Gastroenterology, Copenhagen University Hospital, Rigshospitalet, Denmark. khaderslev@dadlnet.dk
Jeppesen
P B
PB
Hartmann
B
B
Thulesen
J
J
Sorensen
H A
HA
Graff
J
J
Hansen
B S
BS
Tofteng
F
F
Poulsen
S S
SS
Madsen
J L
JL
Holst
J J
JJ
Staun
M
M
Mortensen
P B
PB
D015502:Absorptiometry, Photon; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000596:Amino Acids / Q000097:blood; D015519:Bone Density / Q000187:drug effects*; D001851:Bone Diseases, Metabolic / Q000209:etiology; D016723:Bone Remodeling / Q000187:drug effects*; D002118:Calcium / Q000378:metabolism; D005260:Female; D005768:Gastrointestinal Hormones / Q000627:therapeutic use*; D005934:Glucagon / Q000276:immunology*; D053767:Glucagon-Like Peptide 2; D004763:Glucagon-Like Peptides; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D007408:Intestinal Absorption / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D010024:Osteoporosis / Q000209:etiology; D010281:Parathyroid Hormone / Q000097:blood; D010455:Peptides / Q000627:therapeutic use*; D010865:Pilot Projects; D012778:Short Bowel Syndrome / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D014807:Vitamin D / Q000378:metabolism
D000596:Amino Acids; D005768:Gastrointestinal Hormones; D053767:Glucagon-Like Peptide 2; D006728:Hormones; D010281:Parathyroid Hormone; D010455:Peptides; D015675:Osteocalcin; D014807:Vitamin D; D004763:Glucagon-Like Peptides; C015484:pyridinoline; C036020:deoxypyridinoline; D005934:Glucagon; D000469:Alkaline Phosphatase; D002118:Calcium