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Corticosteroid-induced osteoporosis: does it occur in patients with Crohn's disease?
D J de Jong1, F H M Corstens, L Mannaerts
1Department of Gastroenterology, University Medical Center Nijmegen, The Netherlands.
Insights
Body mass index and bowel resection history predict bone density in Crohn's disease patients. Steroid use did not independently affect bone mineral density in this study.
Area of Science:
- Gastroenterology
- Endocrinology
- Orthopedics
Background:
- Osteoporosis is a common complication in Crohn's disease (CD).
- The exact causes of osteoporosis in CD patients are not fully understood.
- Identifying predictive factors for impaired bone mineral density (BMD) is crucial for management.
Purpose of the Study:
- To identify disease-related variables that predict reduced bone mineral density (BMD) in Crohn's disease patients.
- To investigate the relationship between various clinical factors and BMD in CD.
Main Methods:
- 91 Crohn's disease patients underwent BMD assessment using dual-energy x-ray absorptiometry (DXA).
- BMD was measured at the femoral neck and lumbar spine, reported as T-scores and Z-scores.
- Stepwise linear regression analysis identified independent predictors of BMD.
Main Results:
- 30% of patients met criteria for osteoporosis and 50% for osteopenia.
- Lower body mass index (BMI) and a history of bowel resections were significant independent predictors of BMD.
- BMI and bowel resection history explained 28% of the variance in BMD Z-scores.
Conclusions:
- Body mass index (BMI) and a history of bowel resections are key predictors of impaired bone mineral density in Crohn's disease.
- Despite significant corticosteroid use, steroids were not found to be an independent predictor of osteoporosis in this cohort.
Objective:
In Crohn's disease, osteoporosis is frequently found. However, the etiology of osteoporosis remains unclear. The aim of this study was to determine disease-related variables predictive for impaired bone mineral density (BMD).
Methods:
A total of 91 patients with Crohn's disease who were admitted for BMD assessment were enrolled in the study. BMD was measured at the femoral neck and lumbar spine by dual energy x-ray absorptiometry (DXA). Results were expressed as T-score and as age- and sex-matched Z-score. Data were obtained by a questionnaire and from patients' medical records. Stepwise linear regression analysis was used to determine independent variables predictive for BMD.
Results:
Mean age at BMD assessment was 41 +/- 12 yr, duration of disease 11.6 +/- 8.5 yr, and body mass index (BMI) 23.0 +/- 4.1 kg/m2. The cumulative dose of steroids used was 18.7 +/- 19.2 g. Mean Z-scores were less than zero (spine, -1.1 +/- 1.3 SD; femur, -1.1 +/- 1.2 SD; p < 0.0001). A total of 27 patients (30%) fulfilled the World Health Organization criteria for osteoporosis and 46 patients (50%) for osteopenia. Osteoporotic patients used more corticosteroids and had longer duration of disease, lower BMI, and more bowel resections than patients with normal BMD. However, in the linear regression analysis, the only significant independent predictors for BMD of the lumbar spine and femoral neck were BMI and history of bowel resections. BMI and history of resections together accounted for 28% of BMD Z-scores.
Conclusions:
BMI and a history of bowel resections were significant predictive variables for BMD. Despite the high dose of steroids used in this study, no detrimental effect could be demonstrated as independent predictor for osteoporosis.