Summary Background : A high prevalence of osteoporosis has been noted in Crohn's disease, but data about fractures are scarce. Methods : The relationship between low bone mineral density and the prevalence of vertebral fractures was studied in 271 patients with ileo‐caecal Crohn's disease in a large European/Israeli study. One hundred and eighty‐one currently steroid‐free patients with active Crohn's disease (98 completely steroid‐naive) and 90 steroid‐dependent patients with inactive or quiescent Crohn's disease were investigated by dual X‐ray absorptiometry scan of the lumbar spine, a standardized posterior/anterior and lateral X‐ray of the thoracic and lumbar spine, and an assessment of potential risk factors for osteoporosis. Results : Thirty‐nine asymptomatic fractures were seen in 25 of 179 steroid‐free patients (14.0%; 27 wedge, 12 concavity), and 17 fractures were seen in 13 of 89 steroid‐dependent patients (14.6%; 14 wedge, three concavity). The prevalence of fractures in steroid‐naive patients was 12.4%. The average bone mineral density, expressed as the T‐score, of patients with fractures was not significantly different from that of those without fractures (−0.759 vs. −0.837; P=0.73); 55% of patients with fractures had a normal T‐score. The bone mineral density was negatively correlated with lifetime steroids, but not with previous bowel resection or current disease activity. The fracture rate was not correlated with the bone mineral density (P=0.73) or lifetime steroid dose (P=0.83); in women, but not in men, the fracture rate was correlated with age (P=0.009). Conclusions : The lack of correlation between the prevalence of fractures on the one hand and the bone mineral density and lifetime steroid dose on the other necessitates new hypotheses for the pathogenesis of the former.

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Vrij AA, Jansen JM, Schoon EJ, de Bruṏne A, Hemker HC, Stockbrügger RW. Low molecular weight heparin treatment in steroid refractory ulcerative colitis: clinical outcome and influence on mucosal capillary thrombi. Scand J Gastroenterol 2001;36 Suppl 234:41-47. Background: In ulcerative colitis, a state of hypercoagulation has frequently been observed. Unfractionated heparin has shown bene cial effects as an adjuvant treatment of steroid refractory ulcerative colitis in open trials and in one placebo-controlled trial. Low molecular weight heparin (LMWH) offers advantages in the method of administration, but it has not been evaluated in severe ulcerative colitis. We therefore assessed the tolerability, safety and potential therapeutical effects of LMWH in hospitalized patients with steroid refractory ulcerative colitis. Methods: Twenty-ve patients with severely active ulcerative colitis were included in an open-labelled trial. All patients had a are-up of disease under glucocorticosteroid treatment. Nadroparine calcium 5.700 IE anti-Xa/0.6 mL s.c. was self-administered twice daily for 8 weeks. Patients were monitored for possible adverse events, and changes in clinical symptoms and in laboratory, endoscopical and histological results were analysed. Results: Tolerability and compliance were excellent and no serious adverse events occurred. In 20 of 25 patients, a good clinical and laboratory response was observed. Also, the endoscopic and histological signs of in ammation were found to be signi cantly improved. However, this was not accompanied by a signi cant reduction in the number of mucosal microvascular thrombi after 8 weeks of LMWH treatment. Conclusion: LMWH may be a safe adjuvant therapy for patients with active, glucocorticosteroid refractory ulcerative colitis.

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