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Fracture risk is increased in Crohn's disease, but not in ulcerative colitis
P Vestergaard1, K Krogh, L Rejnmark
1The Osteoporosis Clinic, Aarhus Amtssygehus, Aarhus University Hospital, Denmark.
Insights
Female patients with Crohn's disease have a higher risk of low-energy fractures. This study investigated fracture rates and risk factors in inflammatory bowel disease patients, finding a significant association primarily in women with Crohn's disease.
Area of Science:
- Gastroenterology
- Rheumatology
- Epidemiology
Background:
- Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is associated with various extraintestinal manifestations.
- Fracture risk is a recognized complication in IBD, but specific risk factors and differences between CD and UC require further elucidation.
Purpose of the Study:
- To investigate and compare fracture incidence and associated risk factors in patients diagnosed with Crohn's disease and ulcerative colitis.
- To identify patient demographics and disease-specific factors contributing to increased fracture risk in IBD.
Main Methods:
- A cross-sectional study utilizing self-administered questionnaires distributed to members of the Danish Colitis/Crohn Association and randomly selected controls.
- Analysis included 817 IBD patients (383 CD, 434 UC) and 635 controls, comparing fracture rates and risk factors between groups.
Main Results:
- Female patients with Crohn's disease exhibited a significantly increased risk of fractures (RR=2.5), particularly low-energy fractures of the spine, ribs, pelvis, feet, and toes.
- No increased fracture risk was observed in male Crohn's disease patients or in patients with ulcerative colitis.
- Increased fracture risk in Crohn's disease correlated with the duration of systemic corticosteroid use.
Conclusions:
- Female patients with Crohn's disease face an elevated risk of low-energy fractures, a risk not observed in male CD patients or UC patients.
- Systemic corticosteroid use is a significant risk factor for fractures in Crohn's disease patients.
- These findings highlight the need for targeted fracture prevention strategies in specific IBD patient populations.
Aims:
To study fracture rates and risk factors for fractures in patients with Crohn's disease and ulcerative colitis.
Methods:
998 self administered questionnaires were issued to members of the Danish Colitis/Crohn Association, and 1000 questionnaires were issued to randomly selected control subjects. 845 patients (84.5%) and 645 controls (65.4%) returned the questionnaire (p<0.01). 817 patients and 635 controls could be analysed.
Results:
Analysis was performed on 383 patients with Crohn's disease (median age 39, range 8-82 years; median age at diagnosis 26, range 1-75 years), 434 patients with ulcerative colitis (median age 39, range 11-86 years; median age at diagnosis 29, range 10-78 years), and 635 controls (median age 43, range 19-93 years, p<0.01). The fracture risk was increased in female patients with Crohn's disease (relative risk (RR) = 2.5, 95% confidence interval (CI) 1.7-3.6), but not in male patients with Crohn's disease (RR = 0.6, 95% CI 0.3-1.3) or in patients with ulcerative colitis (RR = 1.1, 95% CI 0.8-1.6). An increased proportion of low energy fractures was observed in patients with Crohn's disease (15.7% versus 1.4 % in controls, 2p<0. 01), but not in patients with ulcerative colitis (5.4%, 2p=0.30). The increased fracture frequency in Crohn's disease was present for fractures of the spine, feet, and toes and fractures of the ribs and pelvis. Fracture risk increased with increasing duration of systemic corticosteroid use in Crohn's disease (2p=0.028), but not in ulcerative colitis (2p=0.50).
Conclusions:
An increased risk of low energy fractures was observed in female patients with Crohn's disease, but not in male patients with Crohn's disease or in patients with ulcerative colitis.
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