Bone mineral density and inflammatory bowel disease severity

Abstract

Inflammatory bowel disease (IBD) is associated with low bone mineral density (BMD). In this study, the association between disease severity and BMD in patients with IBD was evaluated. Associations between BMD and the Montreal classification, disease activity and drug therapy were also tested. A cross-sectional prevalence study with a comparison group was conducted. One hundred and twenty-eight patients were evaluated: 68 patients with ulcerative colitis (UC), and 60 with Crohn's disease (CD). The control group consisted of 67 healthy subjects. All patients and controls had BMD measured and in IBD patients, current medications, hospitalization, and disease location, extent and phenotype, according to the Montreal classification, were recorded. Multiple correspondence analysis was applied to evaluate categorical variables. In the CD group, most patients were diagnosed between 17–40 years of age. Ileocolonic and non-stricturing non-penetrating disease were the most frequent disease location and behavior, respectively. In UC patients, extensive colitis was the most frequent disease location. UC and CD patients were more likely to have osteopenia than controls (OR=14.93/OR=24.38, respectively). In the CD group, male patients, perianal disease, penetrating behavior and age at diagnosis >40 years were associated with low BMD. Taking azathioprine and infliximab also seemed to be associated with osteopenia. In the UC group, we observed an association between low BMD and male patients, left colitis, corticosteroid use and hospitalization. Disease activity was not associated with osteopenia or osteoporosis in CD and UC patients. Disease severity seems to be associated with osteopenia in IBD patients.

Biological Therapy Penetration for Inflammatory Bowel Disease in Latin America: Current Status and Future Challenges

“…The anti-TNF use in CD varied from 1.51% in Mexico up to 46.9% in Colombia. In addition to the aforementioned Mexican study, a study from Cuba (3.8%), one from Brazil (4.8%) and one from Puerto Rico (9.7%) similarly had low biologic penetrations in pa- Lima et al, 2017 (26) Brazil not reported 18.3%…”

Balancing Altered Calcium Metabolism with Bone Health in Sarcoidosis

“…55,56 Similarly, azathioprine may also have deleterious effects on bone health. 57,58 In clinical practice, the impact of azathioprine use on osteoporosis cannot be separated from the impact of disease duration and glucocorticoid use. 59 Infliximab may also be associated with osteoporosis.…”

“…59 Infliximab may also be associated with osteoporosis. 58 However, an analysis of multiple reports concluded that treatment with infliximab and other biologics were associated with better bone health than those receiving other agents, especially glucocorticoids. 60,61 The overall risk for osteoporosis in sarcoidosis remains unclear.…”

Mechanisms Underlying Bone Loss Associated with Gut Inflammation

“…Elevated systemic fibroblast growth factor-23 level was also found to be associated with low BMD in childhood IBD [56], suggesting importance of management of steroids treatment in IBD patients. Prospective clinical trials by introduction of alternative immunosuppressive, such as azathioprine, and anti-tumor necrosis factor (TNF) agents, including infliximab, showed a superior therapeutic effect in IBD patients; however, the association of BMD, drug therapy, and the prevalence of disease activity need to be analyzed further [9].…”

“…Patients with GI disease, especially IBD, are at a significantly higher risk of developing skeletal disease, such as osteoporosis (OP) (17-41% of patients) or osteopenia (22-77% of patients), and other enteropathic arthropathies [7][8][9][10]. OP is a systemic skeletal disease characterized by significantly reduced bone mass/mineral density (BMD) and deterioration of bone microarchitecture [11].…”