Metabolic bone disease in inflammatory bowel disease
- Harold N Rosen, MD
Harold N Rosen, MD
- Assistant Professor in Medicine
- Harvard Medical School
- Section Editors
- Marc K Drezner, MD
Marc K Drezner, MD
- Section Editor — Bone Disease
- Professor of Medicine
- University of Wisconsin Medical School
- Paul Rutgeerts, MD, PhD, FRCP
Paul Rutgeerts, MD, PhD, FRCP
- Section Editor — Inflammatory Bowel Disease
- Emeritus Professor of Medicine
- University Hospital, Leuven, Belgium
Osteoporosis is common in patients with inflammatory bowel diseases (IBD) such as Crohn's disease (CD) or ulcerative colitis (UC). In cross-sectional studies of patients with IBD, the prevalence of osteoporosis ranges from 18 to 42 percent [1,2]. In patients newly diagnosed with IBD, the prevalence is much lower (0 to 5 percent) .
The etiology of low bone mass is multifactorial and includes corticosteroid therapy, disease-related inflammatory activity, malabsorption, and hypogonadism [3,4].
This topic review will focus on the risk factors for and the evaluation and treatment of bone disease in patients with IBD. The diagnosis and treatment of osteoporosis in pre- and postmenopausal women and men and the prevention and treatment of glucocorticoid-induced osteoporosis are reviewed elsewhere. (See "Evaluation and treatment of premenopausal osteoporosis" and "Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women" and "Overview of the management of osteoporosis in postmenopausal women" and "Clinical manifestations, diagnosis, and evaluation of osteoporosis in men" and "Treatment of osteoporosis in men" and "Prevention and treatment of glucocorticoid-induced osteoporosis".)
Bone mineral density — In cross-sectional studies, osteoporosis (T-score <-2.5) has been noted in approximately 18 to 42 percent of patients with established IBD [1,2]. The prevalence of osteopenia (T-score between -1 and -2.5) ranges from 22 to 77 percent . In some [5-8], but not all [9-14], studies, low bone mass is more common in patients with Crohn's disease (CD) than ulcerative colitis (UC).
Fracture — In some [15-17], but not all , population-based studies, there was an increased risk of fracture in individuals with IBD. In the largest study (6027 patients with IBD), the overall fracture rate was higher than that for controls (relative risk [RR] 1.4, 95% CI 1.3-1.6) . The increased risk occurred primarily in older (>60 years) patients. There was no difference between UC and CD. In another study, risk of fracture increased with duration of corticosteroid use .
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- SKELETAL OUTCOMES
- Bone mineral density
- RISK FACTORS
- Disease-related inflammatory activity
- Glucocorticoid therapy
- Alterations in sex hormone status
- Vitamin D and calcium insufficiency
- Other nutritional deficiencies
- Assessment of clinical risk for fracture
- Interpretation of DXA
- BMD monitoring
- Laboratory evaluation
- Lifestyle measures
- Calcium and vitamin D
- Gonadal steroid replacement
- Pharmacologic therapy
- - Candidates for therapy
- - Choice of therapy
- - Efficacy
- Parathyroid hormone
- SUMMARY AND RECOMMENDATIONS