This issue of VHJOE begins a series of articles on Metabolic Bone Disease and the Gastroenterologist by Dr. Peter McNally. Although it may not be widely appreciated, there are many conditions common to gastroenterology practices which can have significant impact on the skeletal system. Malabsorptive processes such as sprue and maldigestive processes such as pancreatic insufficiency can lead to osteoporosis from lack of calcium and vitamin D. Fractures can be the initial presenting symptom in celiac disease. Liver diseases such as primary biliary cirrhosis are known to result in osteoporosis, which can sometimes be the most disabling part of the condition. Even more common it treatment related osteoporosis due to the utilization of steroids in inflammatory bowel disease and autoimmune liver disease.

I have included some images from an elderly woman with autoimmune hepatitis who was unable to tolerate azathioprine, and developed pelvic pain while on prednisone. Her MRI-T1 images (Figures 1, 2) show low intensity lesions in the pelvis (red arrows), and her MRI-T2 images (Figures 3, 4) show high intense signals from these same areas (red arrows) suggesting pelvic fractures. A coronal and transaxial oriented Visible Human model of the pelvis is included (Figures 5, 6) to help orient readers to the location of the bony lesions. We hope the series by Dr. McNally proves useful for our readers.

Figure 1	Figure 2

Figure 3	Figure 4

Figure 5	Figure 6