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Prevalence and predictors of low bone mineral density in males with ulcerative colitis
Nabeel Khan1, Ali M Abbas, Rawaa M Almukhtar
1Southeast Louisiana Veterans Health Care System, Section of Gastroenterology and Hepatology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA. nabeel.khan@va.gov
Context:
Low bone mineral density (BMD) is common in patients with inflammatory bowel diseases.
Objective:
The objective of the study was to assess the prevalence and the predictors of low BMD (osteoporosis or osteopenia) and fragility fractures among men with ulcerative colitis.
Design:
This was a retrospective database analysis.
Setting:
The study was conducted at a nationwide Veterans Affairs health care system.
Patients:
Male ulcerative colitis patients who were followed up in the Veterans Affairs system between 2001 and 2011 were identified using the International Classification of Diseases, ninth revision (ICD-9).
Main Outcome Measures:
We identified patients with low BMD and fragility fractures using ICD-9 codes. Steroid exposure was assessed using pharmacy data. A multivariate analysis was used to identify the independent effect of systemic steroids on the risk of low BMD and fragility fractures.
Results:
We identified 34 665 patients. Among them, 31% used steroids. The prevalence of low BMD was 15.8% and 7.1% among those who used and did not use steroids, respectively (P < .001). Prevalence of fragility fractures was 7.9%, 4.4%, and 1.1% for those with osteoporosis and osteopenia and those without low BMD, respectively (P < .001). Steroid exposure showed a dose-response pattern, patients who had cumulative prednisone exposure of greater than 11 136 mg (10th decile) were more likely to develop low BMD (odds ratio 8.9, P < .001) and fragility fractures (odds ratio 1.8, P < .001) as compared with non-steroid users after controlling for other possible predictors.
Conclusion:
In this nationwide cohort, the prevalence of low BMD was higher than what was reported for the general male population. There was a strong correlation between the cumulative steroid use and the risk of low BMD. Both steroids and low BMD were independent risk factors for fragility fractures.
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