1
|
Koifman E, Krasnopolsky M, Ghersin I, Waterman M. Persistently Elevated C-Reactive Protein Levels and Low Body Mass Index Are Associated with a Lack of Improvement in Bone Mineral Density in Crohn's Disease. Nutrients 2024; 16:2827. [PMID: 39275145 PMCID: PMC11396862 DOI: 10.3390/nu16172827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/14/2024] [Accepted: 08/15/2024] [Indexed: 09/16/2024] Open
Abstract
BACKGROUND Osteoporosis prevalence is increased in Crohn's disease (CD). Its pathogenesis in these patients is incompletely understood. OBJECTIVES To identify factors associated with decreased bone mineral density (BMD) status in CD patients on a time-line course. METHODS A retrospective study was performed that followed CD patients who underwent at least two bone mineral density scans (DEXAs). Follow-up began one year prior to the first DEXA test and lasted at least one year after a second test. Possible correlations between baseline and follow-up variables and changes in BMD status were examined. Change in BMD was defined as a transition from one bone density category to another (normal vs. osteopenia vs. osteoporosis). Binary variables were assessed using the Cochrane-Armitage test. Categorical variables were assessed using the chi-squared test. A multivariate analysis was performed. RESULTS The study included 141 patients. At baseline, 33 patients (23.4%) had normal BMD, 75 (53.2%) had osteopenia, and 33 (23.4%) had osteoporosis. Patients with low BMD had a lower baseline BMI compared to those with normal BMD (p < 0.0001). After a median follow-up of 48 months (IQR 29-71), BMD status worsened in 19 (13.5%) patients, whereas in 95 (67.3%) and 27 (19.1%) patients, BMD remained unchanged or improved, respectively. On the multivariate analysis, elevated median CRP throughout follow-up (OR = 0.8, 95% CI: 0.68-0.93) and low baseline BMI (OR = 0.9, 95% CI: 0.83-0.98) were associated with a lack of BMD status improvement. CONCLUSIONS Persistently elevated CRP and low BMI are associated with a lack of improvement in BMD. These findings underscore the importance of effective inflammation control and nutritional support to maintain and improve bone health.
Collapse
Affiliation(s)
- Eduard Koifman
- Inflammatory Bowel Diseases Service, Gastroenterology Institute, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Meytal Krasnopolsky
- Inflammatory Bowel Diseases Service, Gastroenterology Institute, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Itai Ghersin
- Inflammatory Bowel Diseases Service, Gastroenterology Institute, Rambam Health Care Campus, Haifa 3109601, Israel
| | - Matti Waterman
- Inflammatory Bowel Diseases Service, Gastroenterology Institute, Rambam Health Care Campus, Haifa 3109601, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3109601, Israel
| |
Collapse
|
2
|
Wu S, Ye Z, Yan Y, Zhan X, Ren L, Zhou C, Chen T, Yao Y, Zhu J, Wu S, Ma F, Liu L, Fan B, Liu C. The causal relationship between autoimmune diseases and osteoporosis: a study based on Mendelian randomization. Front Endocrinol (Lausanne) 2023; 14:1196269. [PMID: 37693362 PMCID: PMC10484226 DOI: 10.3389/fendo.2023.1196269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/17/2023] [Indexed: 09/12/2023] Open
Abstract
Objective The relationship between different autoimmune diseases and bone mineral density (BMD) and fractures has been reported in epidemiological studies. This study aimed to explore the causal relationship between autoimmune diseases and BMD, falls, and fractures using Mendelian randomization (MR). Methods The instrumental variables were selected from the aggregated statistical data of these diseases from the largest genome-wide association study in Europe. Specifically, 12 common autoimmune diseases were selected as exposure. Outcome variables included BMD, falls, and fractures. Multiple analysis methods were utilized to comprehensively evaluate the causal relationship between autoimmune diseases and BMD, falls, and fractures. Additionally, sensitivity analyses, including Cochran's Q test, MR-Egger intercept test, and one analysis, were conducted to verify the result's reliability. Results Strong evidence was provided in the results of the negatively association of ulcerative colitis (UC) with forearm BMD. UC also had a negatively association with the total body BMD, while inflammatory bowel disease (IBD) depicted a negatively association with the total body BMD at the age of 45-60 years. Horizontal pleiotropy or heterogeneity was not detected through sensitivity analysis, indicating that the causal estimation was reliable. Conclusion This study shows a negative causal relationship between UC and forearm and total body BMD, and between IBD and total body BMD at the age of 45-60 years. These results should be considered in future research and when public health measures and osteoporosis prevention strategies are formulated.
Collapse
Affiliation(s)
- Shaofeng Wu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhen Ye
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yi Yan
- Department of Operating Room, Taixing People’s Hospital, Taixing, China
| | - Xinli Zhan
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liang Ren
- Reproductive Medicine Center, The First Afliated Hospital of Guangxi Medical University, Nanning, China
| | - Chenxing Zhou
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tianyou Chen
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yuanlin Yao
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jichong Zhu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Siling Wu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fengzhi Ma
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Liu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Binguang Fan
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chong Liu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
3
|
Tulewicz-Marti EM, Lewandowski K, Rydzewska G. Bone Metabolism Alteration in Patients with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11144138. [PMID: 35887903 PMCID: PMC9316624 DOI: 10.3390/jcm11144138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/04/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn’s disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids.
Collapse
Affiliation(s)
- Edyta Maria Tulewicz-Marti
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Correspondence:
| | - Konrad Lewandowski
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
| | - Grażyna Rydzewska
- Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Subdivision, Central Clinical Hospital of the Ministry of Interior and Administration, 02-507 Warsaw, Poland; (K.L.); (G.R.)
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
| |
Collapse
|
4
|
Wu F, Huang Y, Hu J, Shao Z. Mendelian randomization study of inflammatory bowel disease and bone mineral density. BMC Med 2020; 18:312. [PMID: 33167994 PMCID: PMC7654011 DOI: 10.1186/s12916-020-01778-5] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recently, the association between inflammatory bowel disease (including ulcerative colitis and Crohn's disease) and BMD has attracted great interest in the research community. However, the results of the published epidemiological observational studies on the relationship between inflammatory bowel disease and BMD are still inconclusive. Here, we performed a two-sample Mendelian randomization analysis to investigate the causal link between inflammatory bowel disease and level of BMD using publically available GWAS summary statistics. METHODS A series of quality control steps were taken in our analysis to select eligible instrumental SNPs which were strongly associated with exposure. To make the conclusions more robust and reliable, we utilized several robust analytical methods (inverse-variance weighting, MR-PRESSO method, mode-based estimate method, weighted median, MR-Egger regression, and MR.RAPS method) that are based on different assumptions of two-sample MR analysis. The MR-Egger intercept test, Cochran's Q test, and "leave-one-out" sensitivity analysis were performed to evaluate the horizontal pleiotropy, heterogeneities, and stability of these genetic variants on BMD. Outlier variants identified by the MR-PRESSO outlier test were removed step-by-step to reduce heterogeneity and the effect of horizontal pleiotropy. RESULTS Our two-sample Mendelian randomization analysis with two groups of exposure GWAS summary statistics and four groups of outcome GWAS summary statistics suggested a definitively causal effect of genetically predicted ulcerative colitis on TB-BMD and FA-BMD but not on FN-BMD or LS-BMD (after Bonferroni correction), and we merely determined a causal effect of Crohn's disease on FN-BMD but not on the others, which was somewhat inconsistent with many published observational researches. The causal effect of inflammatory bowel disease on TB-BMD was significant and robust but not on FA-BMD, FN-BMD, and LS-BMD, which might result from the cumulative effect of ulcerative colitis and Crohn's disease on BMDs. CONCLUSIONS Our Mendelian randomization analysis supported the causal effect of ulcerative colitis on TB-BMD and FA-BMD. As to Crohn's disease, only the definitively causal effect of it on decreased FN-BMD was observed. Updated MR analysis is warranted to confirm our findings when a more advanced method to get less biased estimates and better precision or GWAS summary data with more ulcerative colitis and Crohn's disease patients was available.
Collapse
Affiliation(s)
- Fashuai Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Yu Huang
- Department of Otorhinolaryngology, The Third Hospital of Wuhan City, Wuhan, 430070, China
| | - Jialu Hu
- School of Computer Science, Northwestern Polytechnical University, West Youyi Road 127, Xi'an, 710072, China.
| | - Zengwu Shao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
5
|
Kärnsund S, Lo B, Bendtsen F, Holm J, Burisch J. Systematic review of the prevalence and development of osteoporosis or low bone mineral density and its risk factors in patients with inflammatory bowel disease. World J Gastroenterol 2020; 26:5362-5374. [PMID: 32994694 PMCID: PMC7504246 DOI: 10.3748/wjg.v26.i35.5362] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/04/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The inflammatory bowel diseases (IBD), Crohn’s disease (CD) and ulcerative colitis (UC) are chronic, immune-mediated disorders of the digestive tract. IBD is considered to be a risk factor for developing osteoporosis; however current literature on this matter is inconsistent.
AIM To assess prevalence and development of osteoporosis and low bone mineral density (BMD), and its risk factors, in IBD patients.
METHODS Systematic review of population-based studies. Studies were identified by electronic (January 2018) and manual searches (May 2018). Databases searched included EMBASE and PubMed and abstracts from 2014-2018 presented at the United European Gastroenterology Week, the European Crohn’s and Colitis Organisation congress, and Digestive Disease Week were screened. Studies were eligible for inclusion if they investigated either the prevalence of osteoporosis or osteopenia and/or risk factors for osteoporosis or low BMD in IBD patients. Studies on children under the age of 18 were excluded. Only population-based studies were included. All risk factors for osteoporosis and low BMD investigated in any included article were considered. Study quality and the possibility of bias were analysed using the Newcastle-Ottawa scale.
RESULTS Twelve studies including 3661 IBD patients and 12789 healthy controls were included. Prevalence of osteoporosis varied between 4%-9% in studies including both CD and UC patients; 2%-9% in studies including UC patients, and 7%-15% in studies including CD patients. Among healthy controls, prevalence of osteoporosis was 3% and 10% in two studies. CD diagnosis, lower body mass index (BMI), and lower body weight were risk factors associated with osteoporosis or low BMD. Findings regarding gender showed inconsistent results. CD patients had an increased risk for osteoporosis or low BMD over time, while UC patients did not. Increased age was associated with decreased BMD, and there was a positive association between weight and BMI and BMD over time. Great heterogeneity was found in the included studies in terms of study methodologies, definitions and the assessment of osteoporosis, and only a small number of population-based studies was available.
CONCLUSION This systematic review found a possible increase of prevalence of osteoporosis in CD cohorts when compared to UC and cohorts including both disease types. Lower weight and lower BMI were predictors of osteoporosis or low BMD in IBD patients. The results varied considerably between studies.
Collapse
Affiliation(s)
- Sofia Kärnsund
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| | - Jakob Holm
- Department of Endocrinology, Copenhagen University Hospital Herlev, Herlev 4600, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre 2650, Denmark
| |
Collapse
|
6
|
Ewid M, Al Mutiri N, Al Omar K, Shamsan AN, Rathore AA, Saquib N, Salaas A, Al Sarraj O, Nasri Y, Attal A, Tawfiq A, Sherif H. Updated bone mineral density status in Saudi patients with inflammatory bowel disease. World J Gastroenterol 2020; 26:5343-5353. [PMID: 32994692 PMCID: PMC7504241 DOI: 10.3748/wjg.v26.i35.5343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/15/2020] [Accepted: 08/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about inflammatory bowel disease (IBD) burden and its impact on bone mineral density (BMD) among adult patients in Saudi Arabia. To the best of our knowledge, our study is the only study to give an update about this health problem in adult Saudi patients with IBD. IBD is a great risk factor for reduced BMD due to its associated chronic inflammation, malabsorption, weight loss and medication side effects. Consequently, screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients. AIM To assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD. METHODS Ninety adult patients with IBD - 62 Crohn's disease (CD) and 28 ulcerative colitis (UC) - were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah, Al-Qassim. All enrolled patients were interviewed for their demographic information and for IBD- and BMD-related clinical data. All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD. RESULTS The CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group; 44% of the CD patients had normal BMD, 19% had osteopenia, and 37% had osteoporosis, while 78% of the UC patients had normal BMD, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), lumbar z-score (r = 0.77, P < 0.05) and femur z-score (r = 0.85, P < 0.05). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05). The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59-0.84), with a sensitivity of 77%, and a specificity of 63%. CONCLUSION Saudi patients with IBD still have an increased risk of reduced BMD, more in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.
Collapse
Affiliation(s)
- Mohammed Ewid
- Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
- Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| | - Nawaf Al Mutiri
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Khalid Al Omar
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Amal N Shamsan
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Awais A Rathore
- Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
| | - Nazmus Saquib
- Epidemiology Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Anas Salaas
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Omar Al Sarraj
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Yaman Nasri
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Ahmed Attal
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Abdulrahman Tawfiq
- Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
| | - Hossam Sherif
- Critical Care Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
- Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
| |
Collapse
|
7
|
Lo B, Holm JP, Vester-Andersen MK, Bendtsen F, Vind I, Burisch J. Incidence, Risk Factors and Evaluation of Osteoporosis in Patients With Inflammatory Bowel Disease: A Danish Population-Based Inception Cohort With 10 Years of Follow-Up. J Crohns Colitis 2020; 14:904-914. [PMID: 32016388 DOI: 10.1093/ecco-jcc/jjaa019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease [IBD] including Crohn's disease [CD] and ulcerative colitis [UC] are at risk of developing metabolic bone disease. The aims here were to investigate the screening strategy, incidence and risk factors of osteoporosis in a prospective population-based inception cohort. METHOD Between 2003 and 2004 all incident patients diagnosed with CD and UC in a well-defined Copenhagen area were included and followed until 2015. Data were compared with a control population [at a ratio of 1:20]. Regression models were performed with several covariates. The sensitivity of the Danish registries for osteoporosis was also assessed. RESULTS A total of 513 patients were included [213 CD, 300 UC]. Overall, 338 (66%, CD: 164 [77%], UC: 174 [58%], p < 0.001] patients received ≥ 500 mg corticosteroid within a year, resulting in 781 patient-years at risk of osteoporosis. Of those, only 83 [10.6%] patient-years were followed by a dual-energy X-ray absorptiometry scan within the same or the following 2 years.Overall, 73 [14.2%] IBD patients (CD: 31 [14.6%], UC: 42 [14%]) and 680 [6.6%, p < 0.001] controls were diagnosed with osteoporosis during follow-up. The risk of osteoporosis was increased compared to the control population (odds ratio: CD: 2.9 [95% confidence interval: 2.0-4.1], UC: 2.8 [2.1-3.9]). CONCLUSION In this population-based inception cohort, the incidence of osteoporosis was significantly higher compared to a control population. Measurement of bone mineral density is infrequent, especially in patients at high risk of developing osteoporosis. These results demonstrate the need of further awareness of the risk of osteoporosis among IBD patients, and prospective population-based studies are warranted.
Collapse
Affiliation(s)
- Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Jakob Præst Holm
- Deparment of Endocrinology, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Marianne Kajbæk Vester-Andersen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Medical Department, Zealand University Hospital, Koege, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| |
Collapse
|
8
|
Levy‐Shraga Y, Shenkar A, Modan‐Moses D, Assa A, Haberman Y, Shouval D, Guz‐Mark A, Lahad A, Weiss B. Longitudinal changes in bone mineral density in children with inflammatory bowel diseases. Acta Paediatr 2020; 109:1026-1032. [PMID: 31594031 DOI: 10.1111/apa.15046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/22/2019] [Accepted: 10/04/2019] [Indexed: 12/30/2022]
Abstract
AIM Children with inflammatory bowel disease (IBD) are prone to low bone mineral density (BMD). Our aim was to assess longitudinal changes in BMD in this population. METHODS A retrospective longitudinal study of children with IBD, treated at two tertiary centres in Israel, who underwent two BMD measurements by dual-energy X-ray absorptiometry (DXA). Changes in lumbar spine BMD (∆L1-4 z-scores) were examined for correlations with clinical characteristics. RESULTS The cohort included 41 patients (age at diagnosis 12.1 ± 3.5 years, 23 females).The mean interval between the scans was 3.4 ± 2.0 years. There was a trend towards improvement in L1-4 z-scores (-1.64 ± 1.02 vs -1.45 ± 0.83, P = .12). ∆L1-4 z-scores correlated positively with ∆weight-standard deviation scores (SDS), ∆height-SDS and ∆BMI-SDS, and with age at the second scan (R = .55, P < .01; R = .42, P < .01; R = .42, P = .01; R = .35, P = .02, respectively); and negatively with L1-4 z-scores at the first scan (R = -.63, P < .01). Stepwise linear regression analysis identified the first scan L1-4 z-scores and ∆weight-SDS as independent predictors of ∆L1-4 z-scores. An L1-4 z-score ≤-2 at the first DXA scan was associated with significant improvement at the second scan. CONCLUSION Improvement in BMD was more pronounced in children who gained weight or whose BMD was low at the first scan.
Collapse
Affiliation(s)
- Yael Levy‐Shraga
- Pediatric Endocrinology and Diabetes Unit The Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel‐Hashomer Israel
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Anatoly Shenkar
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Dalit Modan‐Moses
- Pediatric Endocrinology and Diabetes Unit The Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel‐Hashomer Israel
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
| | - Amit Assa
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Institute of Gastroenterology, Nutrition and Liver Disease Schneider Children's Medical Center Petah‐Tikva Israel
| | - Yael Haberman
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Division of Pediatric Gastroenterology and Nutrition Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel Hashomer Israel
| | - Dror Shouval
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Division of Pediatric Gastroenterology and Nutrition Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel Hashomer Israel
| | - Anat Guz‐Mark
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Institute of Gastroenterology, Nutrition and Liver Disease Schneider Children's Medical Center Petah‐Tikva Israel
| | - Avishay Lahad
- Division of Pediatric Gastroenterology and Nutrition Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel Hashomer Israel
| | - Batia Weiss
- The Sackler Faculty of Medicine Tel‐Aviv University Tel‐Aviv Israel
- Division of Pediatric Gastroenterology and Nutrition Edmond and Lily Safra Children's Hospital Sheba Medical Center Tel Hashomer Israel
| |
Collapse
|
9
|
Sgambato D, Gimigliano F, De Musis C, Moretti A, Toro G, Ferrante E, Miranda A, De Mauro D, Romano L, Iolascon G, Romano M. Bone alterations in inflammatory bowel diseases. World J Clin Cases 2019; 7:1908-1925. [PMID: PMID: 31423424 PMCID: PMC6695530 DOI: 10.12998/wjcc.v7.i15.1908] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/14/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are characterized by a multifactorial partially unknown etiology that involves genetic, immunological and environmental factors. Up to 50% of IBD patients experience at least one extraintestinal manifestation; among them is the involvement of bone density which is referred to as metabolic bone disease (MBD), including osteopenia and osteoporosis. Bone alterations in IBDs population appear to have a multifactorial etiology: Decreased physical activity, inflammation-related bone resorption, multiple intestinal resections, dietary malabsorption of minerals and vitamin D deficiency, genetic factors, gut-bone immune signaling interaction, steroid treatment, microbiota and pathogenic micro-organisms interaction, and dietary malabsorption of minerals, that, all together or individually, may contribute to the alteration of bone mineral density. This review aims to summarize the prevalence and pathophysiology of metabolic bone alterations in IBD subjects outlining the main risk factors of bone fragility. We also want to underline the role of the screening and prophylaxis of bone alterations in Crohn’s disease and ulcerative colitis patients and the importance of treating appropriately MBD.
Collapse
Affiliation(s)
- Dolores Sgambato
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Cristiana De Musis
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Emanuele Ferrante
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Agnese Miranda
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Domenico De Mauro
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| | - Lorenzo Romano
- Surgical Digestive Endoscopy, Department of Clinical Medicine and Surgery, Federico II University, Naples 80131, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
| | - Marco Romano
- Departments of Precision Medicine and Polyspecialistic Internal Medicine, University of Campania ‘‘Luigi Vanvitelli’’ and University Hospital, Naples 80131, Italy
| |
Collapse
|
10
|
Schüle S, Rossel JB, Frey D, Biedermann L, Scharl M, Zeitz J, Freitas-Queiroz N, Kuntzen T, Greuter T, Vavricka SR, Rogler G, Misselwitz B. Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study. Medicine (Baltimore) 2017; 96:e6788. [PMID: 28562531 PMCID: PMC5459696 DOI: 10.1097/md.0000000000006788] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 02/06/2023] Open
Abstract
Low bone mineral density (BMD) and osteoporosis remain frequent problems in patients with inflammatory bowel diseases (IBDs). Several guidelines with nonidentical recommendations exist and there is no general agreement regarding the optimal approach for osteoporosis screening in IBD patients. Clinical practice of osteoporosis screening and treatment remains insufficiently investigated.In the year 2014, a chart review of 877 patients included in the Swiss IBD Cohort study was performed to assess details of osteoporosis diagnostics and treatment. BMD measurements, osteoporosis treatment, and IBD medication were recorded.Our chart review revealed 253 dual-energy x-ray absorptiometry (DXA) scans in 877 IBD patients; osteoporosis was prevalent in 20% of tested patients. We identified widely differing osteoporosis screening rates among centers (11%-62%). A multivariate logistic regression analysis identified predictive factors for screening including steroid usage, long disease duration, and perianal disease; even after correction for all risk factors, the study center remained a strong independent predictor (odds ratio 2.3-21 compared to the center with the lowest screening rate). Treatment rates for patients with osteoporosis were suboptimal (55% for calcium, 65% for vitamin D) at the time of chart review. Similarly, a significant fraction of patients with current steroid medication were not treated with vitamin D or calcium (treatment rates 53% for calcium, 58% for vitamin D). For only 29% of patients with osteoporosis bisphosphonate treatment was started. Treatment rates also differed among centers, generally following screening rates. In patients with longitudinal DXA scans, calcium and vitamin D usage was significantly associated with improvement of BMD over time.Our analysis identified inconsistent usage of osteoporosis screening and underuse of osteoporosis treatment in IBD patients. Increasing awareness of osteoporosis as a significant clinical problem in IBD patients might improve patient care.
Collapse
Affiliation(s)
- Solvey Schüle
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Jean-Benoît Rossel
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne
| | - Diana Frey
- Division of Rheumatology, University Hospital Zurich and University of Zurich
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Jonas Zeitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Natália Freitas-Queiroz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Thomas Kuntzen
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Stephan R. Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
- Department of Medicine, Division of Gastroenterology, Triemli Hospital, Zurich, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich
| |
Collapse
|
11
|
Guz-Mark A, Rinawi F, Egotubov O, Shimon I, Shamir R, Assa A. Pediatric-onset inflammatory bowel disease poses risk for low bone mineral density at early adulthood. Dig Liver Dis 2017; 49:639-642. [PMID: 28179094 DOI: 10.1016/j.dld.2017.01.151] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/17/2016] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is known to pose a risk for low bone mineral density (BMD) in children and adults. We aimed to evaluate the impact of pediatric-onset IBD on BMD in adulthood. METHODS Records of pediatric-IBD patients were retrospectively reviewed for documentation of dual-energy X-ray absorptiometry (DXA) scans in adulthood. BMD was expressed as z-score. RESULTS Sixty one patients were included. Mean (±SD) age at diagnosis was 14.7 (±2.4) years. Mean age at first DXA scan in adulthood was 23.9 years (±4.8). Median BMD z-score was -1.2 SD (IQR, -1.8 to -0.4), significantly lower than expected in normal population (p<0.001). Osteopenia (BMD z-score ≤-1 SD) was noted in 44.3% (n=27), and osteoporosis (BMD z-score ≤-2.5 SD) in 8.2% (n=5). Bone-status showed no correlation with age, disease severity, vitamin D status at diagnosis, IBD subtype or duration of disease. Positive correlation (r=0.306) was identified between low weight z-score at diagnosis and abnormal bone-status in adulthood. Among 36 patients with multiple DXA scans, there was no significant change in BMD during follow-up of 2.4 years. CONCLUSIONS Osteopenia and osteoporosis are frequent in adult IBD patients with pediatric-onset disease and correlates with low weight z-score at diagnosis.
Collapse
Affiliation(s)
- Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Firas Rinawi
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva, Israel
| | - Oxana Egotubov
- Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel
| | - Ilan Shimon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Institute of Endocrinology, Diabetes and Metabolism, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel
| | - Raanan Shamir
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Assa
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
12
|
Schüle S, Rossel JB, Frey D, Biedermann L, Scharl M, Zeitz J, Freitas-Queiroz N, Pittet V, Vavricka SR, Rogler G, Misselwitz B. Prediction of low bone mineral density in patients with inflammatory bowel diseases. United European Gastroenterol J 2016; 4:669-676. [PMID: 27733909 DOI: 10.1177/2050640616658224] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/12/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low bone mineral density (BMD) remains a frequent problem in patients with inflammatory bowel diseases (IBD). There is no general agreement regarding osteoporosis screening in IBD patients. METHODS Cases of low BMD and disease characteristics were retrieved from 3172 patients of the Swiss IBD cohort study. Multivariate logistic regression analysis was conducted for predictive modeling. In a subgroup of 877 patients, 253 dual-energy X-ray absorptiometry (DXA) scans were available for validation. RESULTS Low BMD was prevalent in 19% of patients. We identified seven predictive factors: type of IBD, age, recent steroid usage, low body mass index, perianal disease, recent high disease activity and malabsorption syndrome. Low BMD could be predicted with a sensitivity of 79% and a specificity of 64%, a positive predictive value (PPV) of 35% and a negative predictive value (NPV) of 93%. The area under the curve of the receiver operating characteristics was 0.78. In the validation cohort we calculated a PPV of 26% and an NPV of 88%. CONCLUSION We provide a comprehensive analysis of risk factors for low BMD and propose a predictive model with seven clinical variables. The high NPV of models such as ours might help in excluding low BMD to prevent futile investigations.
Collapse
Affiliation(s)
- Solvey Schüle
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Jean-Benoît Rossel
- Institut de Médecine Sociale et Préventive Unité d'Evaluation des Soins Bio2/02/185, Switzerland
| | - Diana Frey
- Division of Rheumatology, University Hospital Zurich and Zurich University, Switzerland
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Jonas Zeitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Natália Freitas-Queiroz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Valérie Pittet
- Institut de Médecine Sociale et Préventive Unité d'Evaluation des Soins Bio2/02/185, Switzerland
| | - Stephan R Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland; Department of Medicine, Division of Gastroenterology, Triemli Hospital, Zurich, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich and Zurich University, Switzerland
| |
Collapse
|
13
|
Wintermeyer E, Ihle C, Ehnert S, Stöckle U, Ochs G, de Zwart P, Flesch I, Bahrs C, Nussler AK. Crucial Role of Vitamin D in the Musculoskeletal System. Nutrients 2016; 8:nu8060319. [PMID: 27258303 PMCID: PMC4924160 DOI: 10.3390/nu8060319] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/10/2016] [Accepted: 05/11/2016] [Indexed: 12/17/2022] Open
Abstract
Vitamin D is well known to exert multiple functions in bone biology, autoimmune diseases, cell growth, inflammation or neuromuscular and other immune functions. It is a fat-soluble vitamin present in many foods. It can be endogenously produced by ultraviolet rays from sunlight when the skin is exposed to initiate vitamin D synthesis. However, since vitamin D is biologically inert when obtained from sun exposure or diet, it must first be activated in human beings before functioning. The kidney and the liver play here a crucial role by hydroxylation of vitamin D to 25-hydroxyvitamin D in the liver and to 1,25-dihydroxyvitamin D in the kidney. In the past decades, it has been proven that vitamin D deficiency is involved in many diseases. Due to vitamin D’s central role in the musculoskeletal system and consequently the strong negative impact on bone health in cases of vitamin D deficiency, our aim was to underline its importance in bone physiology by summarizing recent findings on the correlation of vitamin D status and rickets, osteomalacia, osteopenia, primary and secondary osteoporosis as well as sarcopenia and musculoskeletal pain. While these diseases all positively correlate with a vitamin D deficiency, there is a great controversy regarding the appropriate vitamin D supplementation as both positive and negative effects on bone mineral density, musculoskeletal pain and incidence of falls are reported.
Collapse
Affiliation(s)
- Elke Wintermeyer
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Christoph Ihle
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Sabrina Ehnert
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Ulrich Stöckle
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Gunnar Ochs
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Peter de Zwart
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Ingo Flesch
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Christian Bahrs
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| | - Andreas K Nussler
- Eberhard Karls Universität Tübingen, BG Trauma Center, Siegfried Weller Institut, Schnarrenbergstr. 95, Tübingen D-72076, Germany.
| |
Collapse
|
14
|
Dahl K, Ahmed LA, Joakimsen RM, Jørgensen L, Eggen AE, Eriksen EF, Bjørnerem Å. High-sensitivity C-reactive protein is an independent risk factor for non-vertebral fractures in women and men: The Tromsø Study. Bone 2015; 72:65-70. [PMID: 25460573 DOI: 10.1016/j.bone.2014.11.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 11/12/2014] [Accepted: 11/16/2014] [Indexed: 01/15/2023]
Abstract
Low-grade inflammation is associated with fractures, while the relationship between inflammation and bone mineral density (BMD) is less clear. Moreover, any gender differences in the sensitivity to inflammation are still poorly elucidated. We therefore tested the hypothesis that high-sensitivity C-reactive protein (CRP) is an independent risk factor for low BMD and non-vertebral fractures, in both genders, and whether there are gender differences in these associations. CRP levels and BMD at the total hip and femoral neck were measured in 1902 women and 1648 men between 55 and 74 years of age, at baseline in the Tromsø Study, Norway, in 2001-2002. Non-vertebral fractures were registered from hospital X-ray archives during an average of 7.2 years follow-up. Linear regression analyses were used for CRP association with BMD and Cox proportional hazards model for fracture prediction by CRP. During 25 595 person-years follow-up, 366 (19%) women and 126 (8%) men suffered a non-vertebral fracture. There was no association between CRP and BMD in women, but an inverse association in men (p=0.001) after adjustment for age and body mass index. Each standard deviation (SD) increase in log-CRP was associated with an increased risk for non-vertebral fracture by 13% in women and 22% in men (hazard ratios (HRs) 1.13, 95% confidence interval (CI) 1.02-1.26, p=0.026 and 1.22, 95% CI=1.00-1.48, p=0.046, respectively). After adjustment for BMD and other risk factors, women with CRP in the upper tertile exhibited 39% higher risk for fracture than those in the lowest tertile of CRP (HR = 1.39, 95% CI = 1.06-1.83, p = 0.017), while men in the upper tertile exhibited 80% higher risk (HR=1.80, 95% CI=1.10-2.94, p=0.019). In summary, CRP was not associated with BMD in women but inversely associated in men, and predicted fractures in both genders. We infer that inflammation influence fracture risk in both women and men, although the biological mechanisms may differ between the genders.
Collapse
Affiliation(s)
- Kristoffer Dahl
- Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Ragnar Martin Joakimsen
- Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway; Department of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Lone Jørgensen
- Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Erik Fink Eriksen
- Department of Clinical Endocrinology, Oslo University Hospital, Oslo, Norway
| | - Åshild Bjørnerem
- Department of Health and Care Sciences, UiT-The Arctic University of Norway, Tromsø, Norway.
| |
Collapse
|
15
|
Wada Y, Hisamatsu T, Naganuma M, Matsuoka K, Okamoto S, Inoue N, Yajima T, Kouyama K, Iwao Y, Ogata H, Hibi T, Abe T, Kanai T. Risk factors for decreased bone mineral density in inflammatory bowel disease: A cross-sectional study. Clin Nutr 2015; 34:1202-9. [PMID: 25618799 DOI: 10.1016/j.clnu.2015.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 12/29/2014] [Accepted: 01/04/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND & AIM Although inflammatory bowel disease (IBD) patients are at risk for metabolic bone disease, studies analyzing this correlation have identified various risk factors, including disease phenotype, age, sex and steroid therapy. Furthermore, few studies have assessed risk factors for bone loss in Japanese IBD patients. This study analyzed risk factors for metabolic bone disease in Japanese IBD patients. METHODS This cross-sectional study assessed 388 patients with IBD aged 20-50 years, including 232 with ulcerative colitis (UC) and 156 with Crohn's disease (CD). Bone mineral density of the femoral neck, total femur and lumbar spine was quantified by dual-energy X-ray absorptiometry. The blood concentrations of bone metabolism markers were measured. History of smoking and bone fracture, and nutritional intake were assessed using questionnaires. RESULTS Of the 388 patients with IBD, 78 (20.1%; UC, 17.2%; CD, 24.4%) had osteopenia and 17 (4.4%; UC, 3.4%; CD, 5.8%) had osteoporosis, as assessed by T-score. Bone mineral density of the lumbar vertebrae was lower in males than in females. Multivariate regression analysis showed that risk factors for bone loss in UC patients were male sex, low body mass index (BMI), high steroid dose and disease location. Risk factors for bone loss in CD patients were male sex and low BMI. CONCLUSION Among Japanese patients with IBD, male sex and low BMI were associated with increased risk for metabolic bone disease. In addition, Steroid therapy shouldn't be indiscriminate in UC patients. These findings may help identify patients at particularly high risk of metabolic bone disease and may help implement appropriate therapies in a timely manner and improve long-term quality of life.
Collapse
Affiliation(s)
- Yasuyo Wada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan; Center for Human Nutrition, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tadakazu Hisamatsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan.
| | - Makoto Naganuma
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Susumu Okamoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Nagamu Inoue
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Tomoharu Yajima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Keisuke Kouyama
- Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan
| | - Yasushi Iwao
- Center for Preventive Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Haruhiko Ogata
- Center for Diagnostic and Therapeutic Endoscopy, School of Medicine, Keio University, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Takayuki Abe
- Center for Clinical Research, School of Medicine, Keio University, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, Keio University, Tokyo, Japan
| |
Collapse
|
16
|
van Bodegraven AA, Bravenboer N, Witte BI, Dijkstra G, van der Woude CJ, Stokkers PCM, Russel MG, Oldenburg B, Pierik M, Roos JC, van Hogezand RA, Dik VK, Oostlander AE, Netelenbos JC, van de Langerijt L, Hommes DW, Lips P. Treatment of bone loss in osteopenic patients with Crohn's disease: a double-blind, randomised trial of oral risedronate 35 mg once weekly or placebo, concomitant with calcium and vitamin D supplementation. Gut 2014; 63:1424-30. [PMID: 24146170 DOI: 10.1136/gutjnl-2013-305523] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Osteoporosis and fractures are frequently encountered in patients with Crohn's disease. In order to prevent fractures, treatment with bone protecting drugs appears warranted early in the course of bone disease when bone loss is not yet prominent. We therefore aimed to demonstrate a beneficial effect on bone density of the bisphosphonate risedronate in osteopenic Crohn's disease patients. METHODS This double-blind, placebo-controlled randomised trial of risedronate with calcium and vitamin D supplementation was performed in osteopenic Crohn's disease patients. Patients were treated for 2 years with follow-up after 3 and after every 6 months. Disease characteristics and activity and bone turnover markers were assessed at all visits; dual x-ray absorptiometry was performed at baseline, 12 and 24 months; radiographs of the spine at baseline and 24 months. RESULTS Of 132 consenting patients, 131 were randomised (67 placebo and 64 risedronate). Patient characteristics were similar in both groups, although the risedronate group was slightly heavier (body mass index 24.3 vs 23.0 kg/m(2)). Bone mineral density at lumbar spine increased 0.04 g/cm(2) on average in the risedronate group versus 0.01 g/cm(2) in the placebo group (p=0.007). The mean increase in total hip bone mineral density was 0.03 versus 0.01 g/cm(2), respectively (p=0.071). Fracture prevalence and incidence were similar. Change of T-scores and concentrations of bone turnover markers were consistent with a beneficial effect of risedronate when compared with placebo. The effect of risedronate was primarily demonstrated in the first 12 months of treatment. No serious unexpected suspected adverse events were observed. CONCLUSIONS A 24-month treatment course with risedronate 35 mg once weekly, concomitant with calcium and vitamin D supplementation, in osteopenic Crohn's disease patients improved bone density at lumbar spine. NTR 163 Dutch Trial Register.
Collapse
Affiliation(s)
- Ad A van Bodegraven
- Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nathalie Bravenboer
- Department of Internal Medicine, Endocrine Section, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands Department of Clinical Chemistry, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Gerard Dijkstra
- Department of Gastroenterology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Pieter C M Stokkers
- Department of Gastroenterology, St Lucas Andreas Hospital, Amsterdam, The Netherlands Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Maurice G Russel
- Department of Gastroenterology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Bas Oldenburg
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marieke Pierik
- Department of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan C Roos
- Department of Nuclear Medicine and Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ruud A van Hogezand
- Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vincent K Dik
- Department of Gastroenterology, VU University Medical Center, Amsterdam, The Netherlands Department of Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela E Oostlander
- Department of Internal Medicine, Endocrine Section, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - J Coen Netelenbos
- Department of Internal Medicine, Endocrine Section, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Daniel W Hommes
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands Department of Gastroenterology, UCLA Health System, Los Angeles, California, USA
| | - Paul Lips
- Department of Internal Medicine, Endocrine Section, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
17
|
Abraham BP, Prasad P, Malaty HM. Vitamin D deficiency and corticosteroid use are risk factors for low bone mineral density in inflammatory bowel disease patients. Dig Dis Sci 2014; 59:1878-84. [PMID: 24619280 DOI: 10.1007/s10620-014-3102-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 02/27/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND As several factors can contribute to low bone mineral density (BMD), we investigated the role of vitamin D in low BMD while controlling for other risk factors in inflammatory bowel diseases (IBD) patients. METHODS We conducted a prospective cross-sectional study between 2008 and 2012 in adult IBD patients. Demographic data including age, gender, ethnicity, BMI, along with disease type and location, vitamin D levels, prior corticosteroid use, and anti-TNF use were recorded and evaluated with DEXA results. RESULTS A total of 166 patients [105 Crohn's disease (CD), 61 ulcerative colitis (UC)] qualified for the study. Low BMD was found in 40%, twice as frequently in CD than in UC (p = 0.048). Higher prevalence of low BMD was associated with those of male gender (p = 0.05), Asian ethnicity (p = 0.02), and history of corticosteroid use (p = 0.001). Age, body mass index, or disease location did not increase the risk of low BMD. The overall prevalence of low vitamin D was 60%, with insufficiency (25-hydroxy levels between 20 and 30 ng/mL) found in 37% and deficiency (levels <20 ng/mL) found in 23% of the patients. Vitamin D insufficient and deficient patients were two times (p = 0.049) and almost 3 times (p = 0.02) as likely to have low BMD, respectively. CONCLUSIONS Low vitamin D, male gender, Asian ethnicity, CD, and corticosteroid use significantly increased the risk of having low BMD, while age and disease location did not affect BMD in our IBD population. It remains important to evaluate for vitamin D nutritional deficiency and limit corticosteroid use to help prevent low BMD in IBD patients.
Collapse
Affiliation(s)
- Bincy P Abraham
- Houston Methodist, 6550 Fannin St. Smith Tower, Suite 1001, Houston, TX, 77030, USA,
| | | | | |
Collapse
|
18
|
Abstract
PURPOSE OF REVIEW To provide a synopsis on established and new research evaluating bone disease in patients with inflammatory bowel disease (IBD). RECENT FINDINGS Persons with IBD, including Crohn's disease and ulcerative colitis are believed to be at high risk for osteoporosis and fracture. As osteoporosis is clinically silent and persons with IBD are not universally screened, the burden of bone disease in IBD has been difficult to accurately assess. It is also unclear whether bone disease is due to inflammatory activity, medication use, poor nutrient intake/absorption, or body habitus characteristics. Recent studies using population-wide databases of bone mineral density (BMD) analyses suggest that Crohn's disease is responsible for a small effect on BMD after adjusting for other risk factors for low BMD, whereas ulcerative colitis does not appear to confer an independent risk. Furthermore, IBD does not appear to be a risk for overall fracture once controlling for factors which are associated with both IBD and fracture risk. The ability to assess BMD on incidentally performed computed tomography scans may allow detection of low BMD in IBD patients. SUMMARY Although reduced BMD and fracture are more common in persons with IBD, the precise burden is not well characterized. Also, the relative impact of IBD-associated factors and IBD-specific inflammation on bone health is still uncertain.
Collapse
|
19
|
Kalantari H, Barekat SM, Maracy MR, Azadbakht L, Shahshahan Z. Nutritional status in patients with ulcerative colitis in Isfahan, Iran. Adv Biomed Res 2014; 3:58. [PMID: 24627866 PMCID: PMC3950790 DOI: 10.4103/2277-9175.125812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 10/21/2012] [Indexed: 12/18/2022] Open
Abstract
Background: Malnutrition is common among patients with inflammatory bowel disease. The present study aimed to investigate the nutritional status of ulcerative colitis (UC) patients in Isfahan, Iran. Materials and Methods: In this descriptive analytical cross-sectional study, between Dec 2011 and Jun 2012, 99 patients with UC were randomly selected and evaluated. Age, sex, duration of disease, body mass index (BMI) and laboratory parameters recorded for all patients. Nutritional risk index (NRI) was calculated and its association with patients’ variables was assessed with regard to UC disease severity. Results: Twelve patients out of 99 patients had mild UC and 87 patients had moderate to severe UC. Based on the NRI, 90.9% were not malnourished and 9.1% were at moderate to severe risk for malnutrition. Among laboratory parameters only, serum potassium level in patients with moderate to severe UC was significantly higher than those with mild UC (P = 0.017). Other laboratory parameters were similar between patients stratified by US status. Patients age s significantly correlate with serum vitamin D, immunoglobulin a (IgA) and potassium level (P > 0.05), also duration of disease was significantly correlate with Phosphorus (P = 0.024) among laboratory parameters. Conclusion: In studied UC patients, malnutrition risk was based on degree of disease severity. Patients with moderate to severe UC were more at risk for malnutrition compared to the patients with mild UC. Furthermore, among laboratory parameters only serum potassium level was higher among patients with moderate to severe UC compared to others.
Collapse
Affiliation(s)
- Hamid Kalantari
- Department of Gastroenterology, Isfahan Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayyed Majid Barekat
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Azadbakht
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Shahshahan
- Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
20
|
Nahidi L, Day AS, Lemberg DA, Leach ST. Paediatric inflammatory bowel disease: a mechanistic approach to investigate exclusive enteral nutrition treatment. SCIENTIFICA 2014; 2014:423817. [PMID: 24967146 PMCID: PMC4055462 DOI: 10.1155/2014/423817] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/24/2014] [Accepted: 05/05/2014] [Indexed: 05/07/2023]
Abstract
The inflammatory bowel diseases (IBD) include Crohn's disease (CD) and ulcerative colitis. The disease may present at any age although the peak of presentation is the second and third decades of life. The incidences of these diseases are increasing around the world with the age of presentation getting younger. At present CD is incurable with colectomy being the treatment for severe UC. Although several pharmacological approaches are used to modulate the inflammatory response in IBD, few lead to histological healing and most have side effects. An alternative approach is to use enteral formulae given exclusively (EEN) to treat IBD. EEN requires the consumption of an elemental or polymeric formula, with the exclusion of all other nutrients, for a period of up to 12 weeks. The introduction of EEN as a therapeutic option for IBD was through prudent observation; however, EEN has become an established and reliable option for the treatment of paediatric IBD. Despite this, the mechanisms through which EEN induces disease remission are unknown and remain hypothetical. This review will discuss recent research into EEN both describing clinical features of EEN therapy and discussing the most up-to-date understanding of the mechanisms through which EEN may be reducing intestinal inflammation and inducing disease remission.
Collapse
Affiliation(s)
- Lily Nahidi
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, NSW 2052, Australia
| | - Andrew S. Day
- Department of Paediatrics, University of Otago, Christchurch, Christchurch 8140, New Zealand
| | - Daniel A. Lemberg
- Department of Gastroenterology, Sydney Children's Hospital, Randwick, Sydney, NSW 2031, Australia
| | - Steven T. Leach
- School of Women's and Children's Health, University of New South Wales, Randwick, Sydney, NSW 2052, Australia
- Westfield Research Laboratories, Level 2, Sydney Children's Hospital, High Street, Randwick, NSW 2031, Australia
- *Steven T. Leach:
| |
Collapse
|
21
|
Trabelsi ABS, Abdellaoui F, Ksiaa M, Souguir A, Zeglaoui H, Ben Rejeb M, Brahem A, Ajmi S, Jmaa A. [The decrease in bone density in chronic inflammatory bowel disease: prevalence and risk factors]. Pan Afr Med J 2013; 15:70. [PMID: 24198872 PMCID: PMC3809964 DOI: 10.11604/pamj.2013.15.70.2859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 06/16/2013] [Indexed: 01/13/2023] Open
|
22
|
Bakker SF, Dik VK, Witte BI, Lips P, Roos JC, Van Bodegraven AA. Increase in bone mineral density in strictly treated Crohn's disease patients with concomitant calcium and vitamin D supplementation. J Crohns Colitis 2013; 7:377-84. [PMID: 22749232 DOI: 10.1016/j.crohns.2012.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 05/01/2012] [Accepted: 06/02/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Decreased bone mineral density (BMD) is common in Crohn's disease (CD) patients. This paper reports on the prevalence of decreased BMD in a referral cohort study of CD-patients next to the change of BMD over time in relation with CD-associated clinical characteristics. METHODS 205 CD patients of a referral hospital were enrolled between January1998-January 2010 when measurement of BMD by dual X-ray absorptiometry (DXA) was available. Follow-up DXA scan was performed in subjects with known risk factors besides Crohn indicative for low BMD. Treatment of CD patients was according to a protocol which is comparable to the current (inter)national guidelines. In osteopenic patients, supplemental vitamin D (800 IU) and Calcium (500-1000 mg) were prescribed. RESULTS Mean BMD at baseline was 0.97 ± 0.16 gram/cm(2) in lumbar spine and 0.87 ± 0.12 gram/cm(2) in the total hip. At baseline, higher age and low Body Mass Index (BMI), were negatively correlated with BMD. Eighty-four patients underwent a second BMD assessment with a median interval period of 4 years (IQR 3-6). A mean annual increase of +0.76% (95%CI: -2.63%; +3.87%) in lumbar spine and +0.43% (95%CI: -2.65% ; +1.11%) in total hip was observed. CONCLUSIONS Higher age, male sex, low BMI, and a higher age at diagnosis of CD were associated with low BMD. Follow-up of BMD in CD patients showed a contraintuitive small increase of BMD at lumbar spine and total hip in CD patients only using supplemental vitamin D and calcium next to strict treatment of CD.
Collapse
Affiliation(s)
- Sjoerd F Bakker
- Department of Gastroenterology and Hepatology, VU University Medical Centre, PO Box 7057, The Netherlands.
| | | | | | | | | | | |
Collapse
|
23
|
Hilmi I, Sunderesvaran K, Ananda V, Sarji SA, Arumugam K, Goh KL. Increased fracture risk and osteoporosis not associated with vitamin D levels in Malaysian patients with inflammatory bowel disease. J Clin Endocrinol Metab 2013; 98:2415-21. [PMID: 23553858 DOI: 10.1210/jc.2013-1147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Osteoporosis and osteopenia are well-recognized complications of inflammatory bowel disease. Previous studies have suggested that vitamin D deficiency is an important risk factor for the development of osteoporosis. We hypothesized that low vitamin D levels is the main reason for reduced bone mineral density in patients with inflammatory bowel disease. We aimed to study its potential role in Malaysia, which is a tropical country with 3 large ethnic groups. We also sought to examine the relationship between fracture risk and bone mineral density in this group. METHODOLOGY Relevant history as well as 25-hydroxycholecalciferol (vitamin D) levels and bone mineral density were obtained. Normal, inadequate, and low vitamin D levels were defined as 61-160 nmol/L (24-64 ng/mL), 30-60 nmol/L (12-24 ng/mL), and less than 30 nmol/L (<12 ng/mL), respectively. RESULTS Seventy-two patients were recruited. The prevalence of osteopenia and osteoporosis, respectively, were 58% and 17% in the spine and 51% and 14% in the hip. Mean vitamin D level in the group was low at 45.12 ± 17.4 nmol/L (18.05 ± 6.96 ng/mL), but there was no significant association between bone mineral density and vitamin D level. Twelve patients (16.7%) had a fragility fracture after the diagnosis of inflammatory bowel disease. The cumulative fracture incidence was 10% at 5 years and 35% at 10 years. There was a statistically significant association between osteoporosis of hip and a history of fracture (odds ratio 5.889; 95% confidence interval 1.41-24.53, P = .009). CONCLUSION Osteoporosis is prevalent among Malaysian patients with inflammatory bowel disease and is associated with a 6-fold increased risk of fractures. Most inflammatory bowel disease patients had inadequate or low vitamin D levels, but there was no association between vitamin D levels and BMD.
Collapse
Affiliation(s)
- Ida Hilmi
- Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | |
Collapse
|
24
|
Azzopardi N, Ellul P. Risk factors for osteoporosis in Crohn's disease: infliximab, corticosteroids, body mass index, and age of onset. Inflamm Bowel Dis 2013; 19:1173-8. [PMID: 23511037 DOI: 10.1097/mib.0b013e31828075a7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND We analyzed the characteristics associated with increased risk of osteoporosis in patients with Crohn's disease in Malta. METHOD Eighty-three patients with histologically and endoscopically confirmed Crohn's disease underwent a DEXA bone density scan and their phenotypic characteristics were analyzed. RESULTS There was a significant association between body mass index and bone mineral density (P = 0.004) and a significant difference in the T scores of patients according to age at diagnosis (Montreal Classification: P = 0.0006) with patients diagnosed <17 years (n = 13) having lower T scores than those diagnosed at older age groups (n = 70). There was a significant difference between the T scores of patients on infliximab (n = 33) and those not on biological therapy (n = 50, P = 0.0058). Patients with high cumulative corticosteroid doses (>10 mg/d for >3 mo, n = 18) had lower bone mineral densities than patients who received smaller corticosteroid doses (P = 0.013). There was however no significant difference in the T scores of patients according to disease location (P = 0.18), disease type (P = 0.64), gender (P = 0.30), and history of ileal resection (P = 0.68). There was also no significant correlation between disease duration and T scores (hip) (P = 0.61). CONCLUSIONS Low body mass index, early disease onset, high corticosteroid doses and, anti-tumor necrosis factor α therapy are associated with increased risk of osteoporosis. Lower T scores in patients on infliximab occur as patients receiving this therapy have more severe inflammation, which is associated with elevated osteoclastogenic factors, rather than as a side-effect of the anti-tumor necrosis factor-α therapy.
Collapse
Affiliation(s)
- Neville Azzopardi
- Division of Gastroenterology, Mater Dei Hospital (Malta), Mellieha, Malta.
| | | |
Collapse
|
25
|
Targownik LE, Bernstein CN, Nugent Z, Johansson H, Oden A, McCloskey E, Kanis JA, Leslie WD. Inflammatory bowel disease and the risk of fracture after controlling for FRAX. J Bone Miner Res 2013; 28:1007-13. [PMID: 23239264 DOI: 10.1002/jbmr.1848] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/19/2012] [Accepted: 11/26/2012] [Indexed: 12/14/2022]
Abstract
Subjects with inflammatory bowel disease (IBD) are at increased risk for hip and other major osteoporotic fractures. However, previous analyses have not fully accounted for differences in bone mineral density (BMD) and other clinical factors that affect the risk of fracture. The World Health Organization Fracture Risk Assessment tool (FRAX) can be used to predict the 10-year fracture risk from BMD and clinical risk factors. A population-based database containing clinical information on all IBD subjects in the province of Manitoba, Canada, was linked with the Manitoba Bone Mineral Density Database, which contains results of all dual X-ray absorptiometry (DXA) scans in the province. FRAX probabilities were calculated for all subjects aged 50 years or more undergoing baseline DXA testing. Subjects were followed for occurrence of major osteoporotic fractures (MOF; hip, clinical spine, wrist, humerus). Cox proportional hazards models were used to determine whether IBD was independently predictive of MOF or hip fracture. After controlling for FRAX fracture probability computed with BMD, IBD was not associated with a significantly increased risk for MOF (hazard ratio [HR] = 1.12, 95% confidence interval [CI], 0.83-1.55) but was associated with an increased risk for hip fracture (HR = 2.14; 95% CI, 1.26-3.65). The addition of femoral neck T-score to FRAX probability without knowledge of BMD had a negligible effect on the estimated HRs for IBD, suggesting that IBD mediates any effect on fracture risk independently of femoral neck BMD. After controlling for FRAX probability, subjects with IBD are not at an increased risk for overall MOF, but may be at increased risk of hip fracture.
Collapse
Affiliation(s)
- Laura E Targownik
- Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Salacinski AJ, Regueiro MD, Broeder CE, McCrory JL. Decreased neuromuscular function in Crohn's disease patients is not associated with low serum vitamin D levels. Dig Dis Sci 2013; 58:526-33. [PMID: 22949179 DOI: 10.1007/s10620-012-2372-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 08/10/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Neuromuscular fatigue is a common complaint in Crohn's disease (CD) patients. A correlation between serum vitamin D concentrations and neuromuscular function has been found in the elderly or non-ambulant populations. AIMS The aim of this study was to determine whether CD patients exhibit impaired neuromuscular function and if so, is there a link between vitamin D and neuromuscular function. METHODS Crohn's disease patients (n = 19) with at least one prior small bowel resection and matched controls (n = 19) underwent muscle strength and endurance testing, vitamin D, and nerve function analysis. RESULTS Knee extension and flexion peak torque (Nm/kg) were greater in the control group than in the CD patients (P = 0.04 and 0.014, respectively. A significant difference was found between fatigue rates of the rectus femoris (P = 0.015) between CD patients and controls, but no difference was found in serum vitamin D levels between groups (P = 0.317). Knee extension and flexion torque measurements, with age as a covariate, were compared with high and low vitamin D levels. Those subjects with high serum vitamin D levels had a significantly greater extension peak torque (P = 0.045) and extension average torque (Nm/kg) (P = 0.014) than those with low levels. CONCLUSION Crohn's disease patients with sufficient vitamin D levels experienced a 43 % greater extension peak torque. Although vitamin D deficiency has been associated with neuromuscular dysfunction, there were no differences in serum vitamin D levels between the CD and healthy controls to explain the decreased muscle strength.
Collapse
Affiliation(s)
- Amanda J Salacinski
- Department of Kinesiology and Physical Education, Northern Illinois University, 204 Anderson Hall, DeKalb, IL 60115, USA.
| | | | | | | |
Collapse
|
27
|
Targownik LE, Leslie WD, Carr R, Clara I, Miller N, Rogala L, Graff LA, Walker JR, Bernstein CN. Longitudinal change in bone mineral density in a population-based cohort of patients with inflammatory bowel disease. Calcif Tissue Int 2012; 91:356-63. [PMID: 22983212 DOI: 10.1007/s00223-012-9650-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/16/2012] [Indexed: 01/21/2023]
Abstract
Persons with inflammatory bowel disease (IBD) are reported to have a high prevalence of osteoporosis and reduced bone mineral density (BMD) and to be at higher risk of fracture. The course of BMD loss over time is poorly characterized in persons with IBD. Eighty-six persons, stratified by age, were enrolled from a population-based longitudinal IBD cohort study to undergo BMD testing at baseline, with final BMD testing a mean of 4.3 years later. The proportion of subjects with significant change in BMD at the lumbar spine, total hip, and femoral neck was assessed, as were clinical, biochemical, and anthropomorphic changes. Vertebral radiographs were also obtained at baseline and at the end of follow-up in those aged 50 years and above to detect vertebral fractures. The change in BMD seen in this cohort of IBD patients was similar to the expected rate of BMD loss in the general population. Age >50 years, decreasing body mass index (BMI), and corticosteroid use were most notably correlated with BMD loss. Subjects aged <50 years did not have statistically significant declines in BMD. IBD symptom activity scores correlated poorly with BMD loss. Vertebral fractures were uncommon, with only two subjects out of 41 >50 years old developing a definite radiographic fracture over the course of follow-up. No major nonvertebral fractures were observed. Patients with IBD do not appear to have significantly accelerated BMD loss. Older age, decreasing BMI, and corticosteroid use may identify IBD patients at greater risk for BMD loss.
Collapse
Affiliation(s)
- Laura E Targownik
- Section of Gastroenterology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Soo I, Siffledeen J, Siminoski K, McQueen B, Fedorak RN. Risedronate improves bone mineral density in Crohn's disease: a two year randomized controlled clinical trial. J Crohns Colitis 2012; 6:777-86. [PMID: 22398088 DOI: 10.1016/j.crohns.2012.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with Crohn's disease have an increased frequency of osteopenia and osteoporosis. This randomized, controlled, double-blind study assessed the efficacy of risedronate versus placebo in treating low bone mineral density (BMD) in patients with Crohn's disease. METHODS 88 Crohn's disease outpatients with BMD T-score<-1.0 by dual-energy X-ray absorptiometry were randomly assigned to one of two treatment groups for the two year study duration: one group received risedronate 35 mg weekly while another received placebo. Both groups received daily calcium (Ca; 500 mg) and vitamin D (D; 400 IU) supplementation. Percent change in BMD relative to baseline was compared between the two therapies at 12 and 24 months. RESULTS Using intent-to-treat analysis, at 12 months, risedronate+Ca+D increased BMD, relative to baseline, more than placebo+Ca+D in the femoral trochanter (1.4±3.4% vs -0.1±3.1%; p=0.03) and total hip (1.1±2.7% vs -0.1±2.5%;p=0.04). This trend in greater BMD continued for the 24 month duration of the study. There was no difference between the two treatment groups for changes in spine BMD. Subgroup analysis revealed that risedronate+Ca+D resulted in significantly better improvement in femoral trochanter BMD in non-smokers (p=0.01), males (p=0.01), those with a history of corticosteroid use in the preceding year (p=0.01), and current users of immunosuppressants (p=0.04). CONCLUSIONS Risedronate, in addition to daily calcium and vitamin D supplementation, is superior to calcium and vitamin D alone in improving femoral trochanter and total hip BMD in patients with Crohn's disease.
Collapse
Affiliation(s)
- Isaac Soo
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | |
Collapse
|
29
|
Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez JM, Luque Fernández I, Varsavsky M, Guadalix Iglesias S, Cano Rodriguez I, Ballesteros Pomar MD, Vidal Casariego A, Rozas Moreno P, Cortés Berdonces M, Fernández García D, Calleja Canelas A, Palma Moya M, Martínez Díaz-Guerra G, Jimenez Moleón JJ, Muñoz Torres M. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. ACTA ACUST UNITED AC 2012; 59:174-96. [PMID: 22321561 DOI: 10.1016/j.endonu.2012.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.
Collapse
|
30
|
Shirazi KM, Somi MH, Rezaeifar P, Fattahi I, Khoshbaten M, Ahmadzadeh M. Bone density and bone metabolism in patients with inflammatory bowel disease. Saudi J Gastroenterol 2012; 18:241-7. [PMID: 22824766 PMCID: PMC3409884 DOI: 10.4103/1319-3767.98428] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND/AIMS Patients with inflammatory bowel disease (IBD) are at high risk for low bone mineral density (BMD). This study aimed to evaluate BMD in IBD patients and its relationship with bone metabolism in a group of Iranian patients. PATIENTS AND METHODS A cross-sectional study was conducted on patients with IBD to assess BMD status and serum biochemical factors. After getting the demographic data from 200 patients, they were screened using dual-energy X-ray absorptiometry of the lumbar spine (L2-L4) and femoral neck for BMD status. Serum levels of calcium, phosphate, alkaline phosphatase (ALP), and 25-hydroxyvitamin D (25-OH vitamin D) were measured to assess the bone metabolism status. RESULTS Two hundred patients with IBD were enrolled in the study. One hundred and eighty three (91.5%) patients were identified as having ulcerative colitis (UC) and 17 (8.5%) as having Crohn's disease (CD). Based on the lumbar and femoral neck bone mass densitometry, 148 (74.4%) patients had low BMD at either lumbar spine or femoral neck. Of these, 100 patients (50.3%) were osteopenic and 48 patients (24.1%) were osteoporotic. A 58.6% and 61% of patients with UC had low BMD in the lumbar and femoral neck, respectively. These results for those with CD were 76.5% and 70.6%, respectively. The mean of femoral neck and lumbar T-scores in patients with UC were -1.14 and -1.38, and in patients with CD were -1.24 and -1.47, respectively (P > 0.05). The mean (±SD) levels for calcium (Ca) in UC and CD were in the normal range. The mean (±SD) levels of ALP and 25-OH vitamin D in both the groups were in the normal range, and in comparison between groups (UC and CD), no significant differences were observed (P = 0.20 for ALP and P = 0.44 for 25-OH vitamin D). In the assessment of correlation between biochemical markers and BMD, an inverse correlation between lumbar T-score and ALP or 25-OH vitamin D only in patients with UC was observed. CONCLUSIONS The high prevalence of low BMD in the Iranian population with IBD needs attention. The subclinical vitamin D deficiency may contribute to bone loss in IBD patients, which is more pronounced in patients with UC in this study because of the small population of patients with CD.
Collapse
Affiliation(s)
- Kourosh M. Shirazi
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad H. Somi
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Rezaeifar
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran,Address for correspondence: Dr. Parisa Rezaeifar, The Internal Medicine Resident of Tabriz University of Medical Sciences, Liver and Gastrointestinal Diseases Research Center, Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran. E-mail:
| | - Ibrahim Fattahi
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran
| | - Manuchehr Khoshbaten
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Ahmadzadeh
- Liver and Gastrointestinal Disease Research Center (LGDRC), Tabriz University of Medical Science Imam Reza Hospital-Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
31
|
Ismail MH, Al-Elq AH, Al-Jarodi ME, Azzam NA, Aljebreen AM, Al-Momen SA, Bseiso BF, Al-Mulhim FA, Alquorain A. Frequency of low bone mineral density in Saudi patients with inflammatory bowel disease. Saudi J Gastroenterol 2012; 18:201-7. [PMID: 22626800 PMCID: PMC3371423 DOI: 10.4103/1319-3767.96458] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors. SETTINGS AND DESIGN We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008. PATIENTS AND METHODS Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines. STATISTICAL ANALYSIS USED Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses. RESULTS Ninety-five patients were included; 46% had Crohn's disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD. CONCLUSIONS Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.
Collapse
Affiliation(s)
- Mona H. Ismail
- Division of Gastroenterology, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia,Address for correspondence: Dr. Mona H. Ismail, University of Dammam, College of Medicine, King Fahd Hospital of the University, Department of Internal Medicine, Division of Gastroenterology, P. O. Box 40149, Al-Khobar 31952, Saudi Arabia. E-mail:
| | - Abdulmohsen H. Al-Elq
- Department of Endocrinology, Departments of Internal Medicine, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
| | - Mahdi E. Al-Jarodi
- Department of Gastroenterology, Dammam Medical Complex, Kingdom of Saudi Arabia
| | - Nahla A. Azzam
- Department of Gastroenterology, King Khalid University Hospital-Riyadh, Kingdom of Saudi Arabia
| | | | - Sami A. Al-Momen
- Department of Gastroenterology, King Fahd Specialist Hospital-Dammam, Kingdom of Saudi Arabia
| | - Bahaa F. Bseiso
- Department of Gastroenterology, King Fahd Specialist Hospital-Dammam, Kingdom of Saudi Arabia
| | - Fatma A. Al-Mulhim
- Department of Radiology, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
| | - Abdulaziz Alquorain
- Division of Gastroenterology, King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia
| |
Collapse
|
32
|
Comparison of the possible risk factors of bone mineral density in subjects with ulcerative colitis and healthy subjects. South Med J 2011; 104:747-51. [PMID: 22024784 DOI: 10.1097/smj.0b013e318232367e] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Inflammatory bowel disease (IBD) is a gastrointestinal system disorder with a variety of causes. The prevalence of reduced bone mineral density (BMD) is greater in people with IBD as compared with healthy individuals. In this study, we aimed to investigate the possible risk factors for low BMD in subjects with ulcerative colitis (UC) and in healthy control subjects. SUBJECTS AND METHODS A total of 40 subjects with UC and 29 healthy subjects were enrolled in the study. Age; sex; body mass index; location and duration of disease; current corticosteroid, azathioprine, or other immunosuppressive medications; smoking; consumption of alcohol, milk, and milk products; menstrual pattern in women; and use of vitamin D, calcium, folic acid, multivitamins, and iron preparations were recorded. BMD was measured by dual-energy x-ray absorptiometry at L2-L4 of the spine and the femoral neck. RESULTS The BMD of patients was found to be lower than that in the control group. The T and z scores of the lumbar vertebra and femoral neck were normal in 21 subjects (52.5%). A total of 17 (42.5%) subjects had osteopenia, and 2 (5%) subjects had osteoporosis. Parathyroid hormone, 1,25(OH)2 vitamin D3, osteocalcin, and urinary markers were found to be similar in both groups. There were no significant differences between subjects with UC and subjects in the control group according to age, sex, and conventional risk factors. CONCLUSIONS The BMD of subjects with UC was found to be lower than that in subjects of similar age and sex in the control group. Our findings suggest that that the disease itself is the most important pathogenic factor contributing to low BMD.
Collapse
|
33
|
Hill RJ, Brookes DSK, Davies PSW. Bones in pediatric Crohn's disease: a review of fracture risk in children and adults. Inflamm Bowel Dis 2011; 17:1223-8. [PMID: 20824813 DOI: 10.1002/ibd.21471] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 07/30/2010] [Indexed: 12/17/2022]
Abstract
There is evidence to suggest that the inflammation associated with Crohn's disease (CD) impacts the bone health of patients, predisposing them to early onset osteoporosis and increasing their risk of fracture. Fractures have been documented in patients with CD, with a high proportion of these being found during young adulthood, which suggests that these patients are not simply fracturing as a result of the normal aging process but rather due to the presence of CD. In population terms, patients with CD have increased risk of fracture compared with the general population. Studies in children suggest that, irrespective of time on corticosteroid therapy, the underlying systemic inflammation associated with CD is an independent detrimental influence on the bone health of children with CD. This poses the question as to whether the onset of disease in childhood predisposes the individual to increased risk of future fractures later in life, as a result of decreased peak bone mass during the growing years. It is generally believed that dual energy x-ray absorptiometry-assessed areal bone mineral density is a good indicator of fracture risk; however, several studies have shown this may not be the case. New research, utilizing peripheral quantitative computed tomography, which provides a true volumetric assessment of bone, suggests altered bone geometry in patients with CD, which poses a structural threat by being more brittle and susceptible to damage accumulation.
Collapse
Affiliation(s)
- Rebecca J Hill
- University of Queensland, Children's Nutrition Research Centre, Herston, Qld, Australia.
| | | | | |
Collapse
|
34
|
Miheller P, Lőrinczy K, Lakatos PL. Clinical relevance of changes in bone metabolism in inflammatory bowel disease. World J Gastroenterol 2010; 16:5536-42. [PMID: 21105186 PMCID: PMC2992671 DOI: 10.3748/wjg.v16.i44.5536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Low bone mineral density is an established, frequent, but often neglected complication in patients with inflammatory bowel disease (IBD). Data regarding the diagnosis, therapy and follow-up of low bone mass in IBD has been partially extrapolated from postmenopausal osteoporosis; however, the pathophysiology of bone loss is altered in young patients with IBD. Fracture, a disabling complication, is the most important clinical outcome of low bone mass. Estimation of fracture risk in IBD is difficult. Numerous risk factors have to be considered, and these factors should be weighed properly to help in the identification of the appropriate patients for screening. In this editorial, the authors aim to highlight the most important clinical aspects of the epidemiology, prevention, diagnosis and treatment of IBD-related bone loss.
Collapse
|
35
|
Miheller P, Lakatos PL, Tóth M. Bone Homeostasis in Intestinal Disorders. Clin Rev Bone Miner Metab 2010. [DOI: 10.1007/s12018-010-9069-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
Poturoglu S, Balkan F, Karaali ZE, Ibrisim D, Yanmaz S, Aktuglu MB, Alioglu T, Kendir M. Relationship between bone mineral density and clinical features in patients with inflammatory bowel disease: a local study in Turkish population. J Int Med Res 2010; 38:62-8. [PMID: 20233514 DOI: 10.1177/147323001003800107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study aimed to compare the bone mineral density (BMD) of patients with ulcerative colitis (UC) and Crohn's disease (CD) in order to determine the possible risk factors for bone loss. A total of 142 patients with UC (n = 88) and CD (n = 54) participated in the study. They were assessed for gender, body mass index (BMI), disease duration and activity, intestinal site of involvement, history of bowel resection, use of steroids, and extra-intestinal findings and complications. The BMD was measured by dual-energy X-ray absorptiometry. There were no differences in BMD between UC and CD patients. In UC patients, BMI showed a significant positive correlation with BMD. Femoral neck Z scores were lower in patients with extra-intestinal findings and complications. Steroid use, disease activity, disease localization, disease duration, bowel surgery and gender had no influence on BMD. Complications or extra-intestinal involvement were a significant predictor for BMD in both groups.
Collapse
Affiliation(s)
- S Poturoglu
- Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Arora G, Singh G, Vadhavkar S, Shah SB, Mannalithara A, Mithal A, Triadafilopoulos G. Incidence and risk of intestinal and extra-intestinal complications in Medicaid patients with inflammatory bowel disease: a 5-year population-based study. Dig Dis Sci 2010; 55:1689-95. [PMID: 20428948 DOI: 10.1007/s10620-010-1236-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2009] [Accepted: 04/06/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Intestinal and extra-intestinal complications are associated with inflammatory bowel disease (IBD) but their exact incidence is not well known. In order to improve our understanding of their incidence and impact, we assessed the complications associated with ulcerative colitis (UC) and Crohn's disease (CD) in a population-based study in Medicaid patients. METHODS We utilized a retrospective cohort design and identified cases of UC and CD using Medi-Cal, the Medicaid program for the State of California. The disease cohort was age- and gender-matched to four controls each and the intestinal and extra-intestinal complications of CD and UC (analyzed separately) were studied over a period of 5 years following the initial diagnosis. RESULTS For UC, the total number of intestinal complications, per 100 cases, was 92 observed compared to 21 expected; the total number of extra-intestinal complications was 42 observed compared to 30 expected. For CD, the number of intestinal complications was 81 observed compared to 20 expected and for extra-intestinal complications, 37 observed compared to 26 expected (all p < 0.001). For both UC and CD, bleeding was the most frequently seen intestinal complication, while the most common extra-intestinal complication was osteoporosis. CONCLUSIONS IBD is associated with several intestinal and extra-intestinal complications of variable incidence and risk. Success of therapeutic regimens should be measured by decreases in incidence, risks, and costs of these complications, in addition to the usual impact on disease activity.
Collapse
Affiliation(s)
- Gaurav Arora
- Division of Gastroenterology, Hepatology and Nutrition, University of Texas Medical School, Houston, TX, USA
| | | | | | | | | | | | | |
Collapse
|
38
|
Larsen S, Bendtzen K, Nielsen OH. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, diagnosis, and management. Ann Med 2010; 42:97-114. [PMID: 20166813 DOI: 10.3109/07853890903559724] [Citation(s) in RCA: 186] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract Extraintestinal manifestations occur rather frequently in inflammatory bowel disease (IBD), e.g. ulcerative colitis (UC) and Crohn's disease (CD). The present paper provides an overview of the epidemiology, clinical characteristics, diagnostic process, and management of rheumatic, metabolic, dermatologic (mucocutaneous), ophthalmologic, hepatobiliary, hematologic, thromboembolic, urinary tract, pulmonary, and pancreatic extraintestinal manifestations related to IBD. Articles were identified through search of the PubMed and Embase databases, the Cochrane Library, and the web sites of the European Agency for the Evaluation of Medicinal Products (EMEA) and the US Food and Drug Administration (FDA) (cut-off date October 2009). The search terms 'Crohn's disease', 'inflammatory bowel disease', or 'ulcerative colitis' were combined with the terms 'adalimumab', 'anemia', 'arthritis', 'bronchiectasis', 'bronchitis', 'cutaneous manifestations', 'erythema nodosum', 'extraintestinal manifestations', 'hyperhomocysteinemia', 'infliximab', 'iridocyclitis', 'lung disease', 'ocular manifestations', 'osteomalacia', 'pancreatitis', 'primary sclerosing cholangitis', 'renal stones', 'sulfasalazine', 'thromboembolism', and 'treatment'. The search was performed on English-language reviews, practical guidelines, letters, and editorials. Articles were selected based on their relevance, and additional papers were retrieved from their reference lists. Since some of the diseases discussed are uncommon, valid evidence of treatment was difficult to obtain, and epidemiologic data on the rarer forms of extraintestinal manifestations are scarce. However, updates on the pathophysiology and treatment regimens are given for each of these disorders. This paper offers a current review of original research papers and randomized clinical trials, if any, within the field and makes an attempt to point out practical guidelines for the diagnosis and treatment of various extraintestinal manifestations related to IBD.
Collapse
Affiliation(s)
- Signe Larsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Denmark
| | | | | |
Collapse
|
39
|
Lucendo AJ, De Rezende LC. Importance of nutrition in inflammatory bowel disease. World J Gastroenterol 2009. [PMID: 19418580 DOI: 10.3748/wjg.15.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
Inflammatory bowel disease (IBD) results from the interaction between an individual's immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro- and micro-nutrients to be rectified. Enteral nutrition is also a primary therapy for IBD, especially for Crohn's disease, as it allows the inflammatory activity to be controlled, kept in remission, and prevents or delays the need for surgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.
Collapse
Affiliation(s)
- Alfredo José Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n. 13700 Tomelloso, Ciudad Real, Spain.
| | | |
Collapse
|
40
|
Abstract
Inflammatory bowel disease (IBD) results from the interaction between an individual’s immune response and precipitant environmental factors, which generate an anomalous chronic inflammatory response in those who are genetically predisposed. Various feeding practices have been implicated in the origin of IBD based on epidemiological observations in developed countries, but we do not have solid evidence for the etiological role played by specific food types. IBD is associated with frequent nutritional deficiencies, the pattern and severity of which depends on the extent, duration and activity of the inflammation. Nutritional support allows these deficiencies in calories, macro- and micro-nutrients to be rectified. Enteral nutrition is also a primary therapy for IBD, especially for Crohn’s disease, as it allows the inflammatory activity to be controlled, kept in remission, and prevents or delays the need for surgery. Nutritional support is especially important in childhood IBD as an alternative to pharmacological treatment. This report discusses the complex relationship between diet and IBD.
Collapse
|
41
|
Gottschalck IB, Jeppesen PB, Hartmann B, Holst JJ, Henriksen DB. Effects of treatment with glucagon-like peptide-2 on bone resorption in colectomized patients with distal ileostomy or jejunostomy and short-bowel syndrome. Scand J Gastroenterol 2009; 43:1304-10. [PMID: 18609184 DOI: 10.1080/00365520802200028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The gut hormone GLP-2 (glucagon-like peptide-2) seems to be involved in the circadian pattern of bone resorption, whereas parathyroid hormone (PTH) is an established key hormone in bone turnover. Endogenous GLP-2 secretion is lacking in colectomized patients with short-bowel syndrome (SBS) and they have reduced bone mineral density (BMD). The aim of the study was to investigate the anti-resorptive effect (assessed by s-CTX) of 14 days of GLP-2 treatment in these patients and to determine whether 56 days of treatment would improve BMD. PTH secretion in response to GLP-2 was also investigated in colectomized SBS patients and colectomized controls (with ileostomy). MATERIAL AND METHODS Eight SBS patients and 13 patients with ileostomy were treated with subcutaneous injections of 1600 microg GLP-2 at bedtime for 56 and 14 consecutive days, respectively. BMD was determined at days 1 and 56 in SBS patients. On days 1 and 14, measurements of CTX, P1NP and PTH were taken 4 h after the GLP-2 injection. RESULTS Patients with ileostomy showed a significant reduction in bone resorption after GLP-2 injections at days 1 and 14. In contrast, there was no change in s-CTX after 1 and 14 days in the SBS patients, and after 56 days of GLP-2 treatment there was no improvement in BMD. A significant reduction in PTH secretion in response to GLP-2 was observed only in patients with ileostomy. CONCLUSIONS The decreased bone resorption in response to GLP-2 injections cannot be elicited in SBS patients and therefore precludes treatment of their osteopenia with GLP-2. The anti-resorptive response to GLP-2 seems to require an intact small intestine and may involve suppression of PTH secretion.
Collapse
|
42
|
Pluskiewicz W, Zdrzałek J, Karasek D. Spine bone mineral density and VDR polymorphism in subjects with ulcerative colitis. J Bone Miner Metab 2009; 27:567-73. [PMID: 19365702 DOI: 10.1007/s00774-009-0072-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/06/2009] [Indexed: 01/05/2023]
Abstract
This study established bone mineral density in subjects with ulcerative colitis with respect to disease dissemination and severity and the association between skeletal status and vitamin D receptor (VDR) polymorphism. Forty-seven patients aged 47.6 +/- 14.8 years and 47 age- and sex-matched control subjects were evaluated. Disease duration was 8.6 +/- 7.2 years. Twenty-four subjects demonstrated mild, 17 moderate, and 5 severe forms of ulcerative colitis; local (proctitis and proctosigmoiditis) changes were present in 26 and disseminated changes in 21. Bone mineral density (BMD, g/cm(2)) was assessed at the spine, and distribution of VDR polymorphism was established. In six patients (12.8%) and in two controls (4.25%), T-score for BMD was below -2.5, but mean values of BMD did not differ between all patients and controls. Patients with moderate and severe form of disease had lower BMD measurements than patients with a mild form of colitis ulcerosa (P < 0.05), and subjects with disseminated intestinal changes had lower BMD measurements than subjects with local changes (P < 0.001). Distribution of VDR polymorphism did not differ between patients and controls. Spine Z-score was dependent on VDR polymorphism (P < 0.05) in male and female patients but not in controls. We concluded that, in patients with ulcerative colitis (UC), spine bone mineral density decreases with progression and dissemination of the disease, and that VDR polymorphism is associated with spine bone mineral density. VDR genotype bb is significantly less likely to cause low BMD in male UC patients, and VDR genotype tt is more likely to cause low BMD in female patients.
Collapse
Affiliation(s)
- Wojciech Pluskiewicz
- Department and Clinic of Internal Diseases, Diabetology and Nephrology, Metabolic Bone Diseases Unit, Medical University of Silesia, Katowice, 3 Maja 13/15 str, 41-800, Zabrze, Poland.
| | | | | |
Collapse
|
43
|
Hamdani G, Gabet Y, Rachmilewitz D, Karmeli F, Bab I, Dresner-Pollak R. Dextran sodium sulfate-induced colitis causes rapid bone loss in mice. Bone 2008; 43:945-50. [PMID: 18675386 DOI: 10.1016/j.bone.2008.06.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Revised: 06/17/2008] [Accepted: 06/25/2008] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Osteopenia is a common complication of human inflammatory bowel disease (IBD). We evaluated the contribution of colonic inflammation to osteopenia and its mechanism in a murine colitis model. METHODS Colitis was induced by adding dextran sodium sulfate (DSS) to the drinking water for 2 weeks to nine-week-old Balb/C male mice. 5% DSS was added on the first week and was reduced to 2.5% on the second week. Age- and sex-matched Balb/C mice served as the control group. Indices of femoral bone mass and architecture were determined by micro computed tomography (muCT). Bone formation parameters and osteoclast number were determined by dynamic histomorphometry. The degree of colonic inflammation was assessed by a clinical disease activity index, and colonic mucosal myeloperoxidase activity. RESULTS DSS-treated mice exhibited a significantly lower bone mass compared to controls as indicated by decreased trabecular bone volume (BV/TV) of 32%. This reduction was accompanied by decreased trabecular number (23%) and connectivity density (37%) compared to the controls. No changes were observed in cortical bone indices. Osteopenia resulted from suppressed bone formation, as indicated by decreased trabecular double-labeled surface (dL%) of 90%, mineralizing surface (MS) of 62%, and bone formation rate (BFR) of 67%, and increased bone resorption as indicated by a 34% increase in osteoclast number in DSS-treated mice compared to the controls. Myeloperoxidase activity inversely correlated with trabecular BV/TV (r=-0.67, p=0.02), trabecular number (r=-0.86, p=0.0008) and connectivity density (r=-0.63, p=0.03). Myeloperoxidase activity inversely correlated with the bone formation indices: dL%, MS, and BFR (r=-0.79, p=0.007, r=-0.84, p=0.002, r=-0.83, p=0.003, respectively). CONCLUSIONS DSS-induced colitis is associated with reduced femoral bone mass and altered micro architecture, which results from suppressed bone formation and increased bone resorption. The decrease in indices of bone mass, structure and formation are directly linked to the degree of colonic mucosal inflammation. DSS-induced colitis can be used to study pharmacological interventions for bone loss in colitis.
Collapse
Affiliation(s)
- Gilad Hamdani
- Hebrew University-Hadassah School of Medicine, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
44
|
Abstract
Half of all patients with inflammatory bowel disease show a significant reduction of their bone mass during the course of their chronic inflammatory disease. In contrast to women with postmenopausal osteoporosis these patients are much younger and a significant subgroup develops vertebral fractures which are mostly asymptomatic. The activity of the chronic inflammatory disease and the steroid treatment leads to bone loss predominantly through the TNFα-driven osteoprotegerin system. Clinical useful genetic markers to identify patients at risk for fractures have not been developed so far. Long-term clinical remission leads in most patients to normalisation of the bone density. Patients with reduced bone density should be substituted with calcium and vitamin D. Patients with vertebral fractures should receive bisphosphonates.
Collapse
Affiliation(s)
- Max Reinshagen
- Department of Medicine I, Klinikum Braunschweig, Germany
| |
Collapse
|
45
|
Rodríguez-Bores L, Barahona-Garrido J, Yamamoto-Furusho JK. Basic and clinical aspects of osteoporosis in inflammatory bowel disease. World J Gastroenterol 2007; 13:6156-65. [PMID: 18069754 PMCID: PMC4171224 DOI: 10.3748/wjg.v13.i46.6156] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Low bone mineral density and the increased risk of fracture in gastrointestinal diseases have a multifactorial pathogenesis. Inflammatory bowel disease (IBD) has been associated with an increased risk of osteoporosis and osteopenia and epidemiologic studies have reported an increased prevalence of low bone mass in patients with IBD. Certainly, genetics play an important role, along with other factors such as systemic inflammation, malnutrition, hypogonadism, glucocorticoid therapy in IBD and other lifestyle factors. At a molecular level the proinflammatory cytokines that contribute to the intestinal immune response in IBD are known to enhance bone resorption. There are genes influencing osteoblast function and it is likely that LRP5 may be involved in the skeletal development. Also the identification of vitamin D receptors (VDRs) and some of its polymorphisms have led to consider the possible relationships between them and some autoimmune diseases and may be involved in the pathogenesis through the exertion of its immunomodulatory effects during inflammation. Trying to explain the physiopathology we have found that there is increasing evidence for the integration between systemic inflammation and bone loss likely mediated via receptor for activated nuclear factor kappa-B (RANK), RANK-ligand, and osteoprotegerin, proteins that can affect both osteoclastogenesis and T-cell activation. Although glucocorticoids can reduce mucosal and systemic inflammation, they have intrinsic qualities that negatively impact on bone mass. It is still controversial if all IBD patients should be screened, especially in patients with preexisting risk factors for bone disease. Available methods to measure BMD include single energy x-ray absorptiometry, DXA, quantitative computed tomography (QCT), radiographic absorptiometry, and ultrasound. DXA is the establish method to determine BMD, and routinely is measured in the hip and the lumbar spine. There are several treatments options that have proven their effectiveness, while new emergent therapies such as calcitonin and teriparatide among others remain to be assessed.
Collapse
|
46
|
Ng V, Millard W, Lebrun C, Howard J. Exercise and Crohn's disease: speculations on potential benefits. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2007; 20:657-60. [PMID: 17066157 PMCID: PMC2660794 DOI: 10.1155/2006/462495] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease that affects nearly one million people in the United States and Canada. While current pharmaceutical treatments are effective in controlling symptoms, patients continue to experience a reduced quality of life (QOL). Based on preliminary studies, QOL in CD patients may be improved by engaging in physical activity. Exercise may decrease CD activity and reduce psychological stress. Current research also suggests that low-intensity exercise does not exacerbate gastrointestinal symptoms and does not lead to flare-ups. Furthermore, exercise appears to reduce CD symptoms and improve QOL. In summary, physical activity may be beneficial to certain patient groups, but more studies are needed before broad recommendations can be made.
Collapse
Affiliation(s)
- Victor Ng
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, London, Ontario
| | - Wanda Millard
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, London, Ontario
- Correspondence: Dr Wanda Millard, Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, London, Ontario N6A 3K7. Telephone 519-661-3011, fax 519-661-3379, e-mail
| | - Constance Lebrun
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, London, Ontario
| | - John Howard
- Department of Pediatrics and Medicine, Schulich School of Medicine, University of Western Ontario, London, Ontario
| |
Collapse
|
47
|
Abstract
Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, is associated with an increased risk of osteoporosis and bone fractures. Initial studies suggested very high rates of osteoporosis in IBD, but more recent studies have suggested that bone mineral density (BMD) is often normal in patients with IBD and typically changes little over time. Nonetheless, IBD is associated with an increased risk of fractures. Doctors managing patients with IBD must consider a variety of risk factors, not just BMD measurements, in assessing fracture risk. Advances have been made in exploring the pathogenesis of osteoporosis in IBD. The evolution of knowledge regarding receptor for activated factor of nuclear factor kappaB (RANK), its ligand RANKL, and osteoprotegerin (OPG), which serves as a decoy receptor, has enhanced the understanding of both osteoporosis and T-cell immunobiology. Recent clinical studies in patients with IBD have revealed that serum OPG levels may be elevated and inflamed intestinal tissue secretes increased amounts of OPG. It is suspected that OPG levels are elevated as a counterregulatory response to low BMD, as serum OPG levels in IBD have been found to be inversely associated with BMD. Finally, in animal models of IBD, exogenous OPG has reversed both the osteopenia and the enterocolitis, suggesting that it may have a therapeutic role in human IBD.
Collapse
Affiliation(s)
- Charles N Bernstein
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, 804F-715 McDermot Avenue, Winnipeg, Manitoba R3E 3P4, Canada.
| |
Collapse
|
48
|
Rothfuss KS, Stange EF, Herrlinger KR. Extraintestinal manifestations and complications in inflammatory bowel diseases. World J Gastroenterol 2006; 12:4819-31. [PMID: 16937463 PMCID: PMC4087615 DOI: 10.3748/wjg.v12.i30.4819] [Citation(s) in RCA: 202] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.
Collapse
Affiliation(s)
- Katja S Rothfuss
- Robert-Bosch-Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Auerbachstrasse 110, D-70376 Stuttgart, Germany.
| | | | | |
Collapse
|
49
|
Abstract
The following are guidelines for evaluation and consideration for treatment of patients with inflammatory bone disease (IBD) after bone mineral density (BMD) measurements. The Crohn's & Colitis Foundation of America (CCFA) has indicated that its recommendations are intended to serve as reference points for clinical decision-making, not as rigid standards, limits, or rules. They should not be interpreted as quality standards.
Collapse
Affiliation(s)
- Gary R Lichtenstein
- University of Pennsylvania School of Medicine, Hospital of the University of Pennsylvania, Gastroenterology Division, Department of Medicine, Philadelphia, PA 19104-4283, USA.
| | | | | |
Collapse
|
50
|
Mentzel HJ, Blume J, Boettcher J, Lehmann G, Tuchscherer D, Pfeil A, Kramer A, Malich A, Kauf E, Hein G, Kaiser WA. The potential of digital X-ray radiogrammetry (DXR) in the assessment of osteopenia in children with chronic inflammatory bowel disease. Pediatr Radiol 2006; 36:415-20. [PMID: 16506029 DOI: 10.1007/s00247-005-0093-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2005] [Revised: 11/15/2005] [Accepted: 12/04/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Loss of bone mass is a known complication of chronic inflammatory bowel disease (IBD) in children. The gold standard in the evaluation of bone mineral density (BMD) is dual energy X-ray absorptiometry (DXA). OBJECTIVE In this preliminary study we evaluated digital X-ray radiogrammetry (DXR) which estimates BMD (DXR-BMD) from hand radiographs in children with IBD. MATERIALS AND METHODS A total of 26 children with IBD (10 girls, 16 boys; age range 10-18 years) underwent DXR for the calculation of DXR-BMD and metacarpal index (DXR-MCI) using the Pronosco X-posure system. The results were compared with a local reference database and correlated with the results of DXA. RESULTS DXR-BMD was 0.36-0.56 g/cm(2) (median 0.46 g/cm(2)) in Crohn disease patients and 0.38-0.63 g/cm(2) (median 0.48 g/cm(2)) in ulcerative colitis patients. DXR-MCI was 0.29-0.49 in Crohn disease patients and 0.28-0.53 in ulcerative colitis patients. The Z-scores were reduced to <-1 SD in five Crohn disease patients and in six ulcerative colitis patients. The coefficients (r) for the correlations between DXR-BMD and DXA-BMD were 0.78 for the lumbar spine and 0.61 for the proximal femur (P<0.01), and between DXR-MCI and DXA-BMD were 0.78 for the lumbar spine and 0.51 for the proximal femur (P<0.01). CONCLUSIONS DXR seems to be able to estimate cortical osteopenia in children with chronic IBD. The DXR results showed a positive correlation with DXA results.
Collapse
Affiliation(s)
- Hans-Joachim Mentzel
- Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, Friedrich-Schiller-University Jena, Bachstrasse 18, 07740, Jena, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|