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High prevalence of morphometric vertebral deformities in patients with inflammatory bowel disease
Anna Caroline Heijckmann1, Maya S P Huijberts, Erik J Schoon
1Department of Internal Medicine, Division of Endocrinology, Hospital Bernhoven, Veghel, The Netherlands. caroline@heesen.eu
Insights
Vertebral deformities are common in inflammatory bowel disease (IBD) patients. While not predicted by bone density or turnover, older age and glucocorticoid use increase the risk of multiple deformities.
Area of Science:
- Gastroenterology
- Endocrinology
- Radiology
Background:
- Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is associated with an increased prevalence of decreased bone mineral density (BMD).
- The relationship between IBD, vertebral deformities, BMD, and bone turnover markers requires further investigation.
Purpose of the Study:
- To determine the prevalence of vertebral deformities in patients with CD and UC.
- To assess the association between vertebral deformities, BMD, and bone turnover markers in IBD patients.
Main Methods:
- 109 CD and 72 UC patients underwent BMD measurement of the hip and vertebral assessment using densitometry.
- Serum markers for bone resorption and formation were measured.
- Logistic regression analysis identified determinants of vertebral deformities.
Main Results:
- Vertebral deformities were present in 25% of both CD and UC patients.
- No significant differences in BMD (Z-scores, T-scores) or bone turnover markers were observed between patients with and without vertebral deformities.
- Male sex was the only predictor of any morphometric vertebral deformity; older age and glucocorticoid use were associated with multiple deformities.
Conclusions:
- Morphometric vertebral deformities are highly prevalent in CD and UC patients.
- Vertebral deformity presence was not predicted by disease activity, bone turnover, clinical risk factors, or BMD.
- Age and glucocorticoid use were linked to multiple vertebral deformities, suggesting a need for vertebral assessment alongside BMD screening in IBD.
Background:
Earlier studies have documented that the prevalence of decreased bone mineral density (BMD) is elevated in patients with inflammatory bowel disease. The objective of this study was to investigate the prevalence of vertebral deformities in inflammatory bowel disease patients and their relation with BMD and bone turnover.
Methods:
One hundred and nine patients with Crohn's disease (CD) and 72 with ulcerative colitis (UC) (age 44.5+/-14.2 years) were studied. BMD of the hip (by dual X-ray absorptiometry) was measured and a lateral single energy densitometry of the spine for assessment of vertebral deformities was performed. Serum markers of bone resorption (carboxy-terminal cross-linked telopeptide of type I collagen) and formation (procollagen type I amino-terminal propeptide) were measured, and determinants of prevalent vertebral deformities were assessed using logistic regression analysis.
Results:
Vertebral deformities were found in 25% of both CD and UC patients. Comparing patients with and without vertebral deformities, no significant difference was found between Z-scores and T-scores of BMD, or levels of serum carboxy-terminal cross-linked telopeptide of type I collagen and serum procollagen type I amino-terminal propeptide. Using logistic regression analysis the only determinant of any morphometric vertebral deformity was sex. The presence of multiple vertebral deformities was associated with older age and glucocorticoid use.
Conclusion:
The prevalence of morphometric vertebral deformities is high in CD and UC. Male sex, but neither disease activity, bone turnover markers, clinical risk factors, nor BMD predicted their presence. The determinants for having more than one vertebral deformity were age and glucocorticoid use. This implies that in addition to screening for low BMD, morphometric assessment of vertebral deformities is warranted in CD and UC.
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