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Skeletal morbidity in inflammatory bowel disease
R A van Hogezand1, N A T Hamdy
1Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands. R.A.van_Hogezand.mdlz@lumc.nl
Scandinavian Journal of Gastroenterology. Supplement
|June 20, 2006
Summary
Patients with Crohn's disease face higher risks of bone loss due to inflammation and medication. Screening all Crohn's patients for osteoporosis is recommended to ensure timely treatment for those at risk.
Area of Science:
- Gastroenterology
- Endocrinology
- Rheumatology
Background:
- Crohn's disease (CD) patients exhibit increased risk for bone and mineral metabolism disturbances.
- Factors contributing to bone loss include inflammatory cytokines, intestinal malabsorption, and glucocorticoid use.
- Other potential factors include impaired peak bone mass attainment, malnutrition, immobilization, low BMI, smoking, and hypogonadism.
Purpose of the Study:
- To investigate the controversial relationship between Crohn's disease and bone loss.
- To determine the prevalence of osteoporosis in inflammatory bowel disease (IBD) patients.
- To establish recommendations for screening and managing bone loss in Crohn's disease.
Main Methods:
- Review of existing literature on Crohn's disease, ulcerative colitis, and bone metabolism.
- Analysis of studies reporting osteoporosis prevalence in IBD populations.
- Evaluation of the correlation between bone mineral density (BMD), glucocorticoid use, and disease activity.
Main Results:
- Osteoporosis prevalence in IBD ranges from 12% to 42%, with most studies showing a negative correlation between BMD and glucocorticoid use.
- Bone loss is observed in Crohn's disease patients even without glucocorticoid use.
- Fracture risk data is scarce, but non-vertebral fracture risk may increase by up to 60% in IBD patients.
Conclusions:
- Screening all Crohn's disease patients for osteoporosis via BMD measurement is recommended.
- Correction of calcium and vitamin D deficiencies is crucial.
- This approach allows timely intervention for at-risk patients while avoiding unnecessary treatment for others.