Altered bone metabolism in inflammatory bowel disease: there is a difference between Crohn’s disease and ulcerative colitis

Ardizzone, Sandro; Bollani, S.; Bettica, Paolo; Bevilacqua, Maurizio; Molteni, Paola; Porro, G. Bianchi

doi:10.1046/j.1365-2796.2000.00582.x

Cited by 173 publications

(175 citation statements)

References 26 publications

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“…Moreover, BMD was found to be low despite normal serum 25OHD concentration in many studies of patients with IBD. 33,34,50,51 We found no significant association between serum 25OHD concentration and zLSBMD among our subjects, although there was a high prevalence of low zLSBMD. We selected a time interval of 6 months before or after BMD measurement to assess the vitamin D status of our patients, because our goal was to capture in a cross-sectional manner a serum 25OHD concentration that would be most representative and reflective of the vitamin D status of the patients around the time of their BMD measurement.…”

Section: Discussioncontrasting

confidence: 72%

“…29 Fewer studies have described the vitamin D status of adults with UC compared with those with CD. Serum 25OHD concentrations have been found to be normal in some studies of patients with UC, 33,34 whereas others report serum 25OHD concentrations <12 ng/mL in 15%. 25 In one study, 22 the serum 25OHD concentration was <10 ng/mL in 45% of adult patients with UC and was not different from that in patients with CD.…”

Section: Introductionmentioning

confidence: 98%

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Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Pappa¹,

Gordon

Saslowsky³

et al. 2006

Pediatrics

188

144

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OBJECTIVES-Previous studies of vitamin D status in pediatric patients with inflammatory bowel disease have revealed conflicting results. We sought to report (1) the prevalence of vitamin D deficiency (serum 25-hydroxy-vitamin D concentration ≤15 ng/mL) in a large population with inflammatory bowel disease, (2) factors predisposing to this problem, and (3) its relationship to bone health and serum parathyroid hormone concentration.PATIENTS AND METHODS-A total of 130 patients (8-22 years of age) with inflammatory bowel disease, 94 with Crohn disease and 36 with ulcerative colitis, had serum 25-hydroxyvitamin D, intact parathyroid hormone, and lumbar spine bone mineral density (using dual-energy x-ray absorptiometry) measured at Children's Hospital Boston. RESULTS-The prevalence of vitamin D deficiency was 34.6%. Mean serum 25-hydroxyvitamin D concentration was similar in patients with Crohn disease and ulcerative colitis, 52.6% lower among patients with dark skin complexion, 33.4% lower during the winter months (December 22 to March 21), and 31.5% higher among patients who were taking vitamin D supplements. Serum 25-hydroxy-vitamin D concentration was positively correlated with weight and BMI z score, disease duration, and serum albumin concentration and negatively correlated with erythrocyte sedimentation rate. Patients with Crohn disease and upper gastrointestinal tract involvement were more likely to be vitamin D deficient than those without it. Serum 25-hydroxyvitamin concentration was not associated with lumbar spine bone mineral density z score or serum parathyroid hormone concentration.CONCLUSIONS-Vitamin D deficiency is highly prevalent among pediatric patients with inflammatory bowel disease. Factors predisposing to the problem include having a dark-skin complexion, winter season, lack of vitamin D supplementation, early stage of disease, more severe disease, and upper gastrointestinal tract involvement in patients with Crohn disease. The long-term significance of hypovitaminosis D for this population is unknown at present and merits additional study. Copyright © 2006 by the American Academy of PediatricsAddress correspondence to Helen M. Pappa, MD, MPH, Division of Gastroenterology and Nutrition, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. helen.pappa@childrens.harvard.edu. The authors have indicated they have no financial relationships relevant to this article to disclose. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2011 November 1. Available reports on the vitamin D status of adults with CD place the prevalence of 25OHD concentration ≤15 ng/mL between 22% and 70%, depending on the study. 21-31 Serum 25OHD concentration was found to be <10 ng/mL in 8% to 45% of adults with CD. 21,22,24,26 One study reports a negative relationship among disease duration, Crohn Disease Activity Index, ferritin, C-reactive protein, cholesterol, 24 and 25OHD concentration.Other studies report that smoking 21 and small bowel resection 30,32 are also negativel...

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Section: Discussioncontrasting

confidence: 72%

Section: Introductionmentioning

confidence: 98%

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Pappa¹,

Gordon

Saslowsky³

et al. 2006

Pediatrics

188

144

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“…This may be due to malabsorption, particularly in CD patients who have undergone surgical resection of the small bowel. However, other studies, including ours, have shown little or no difference between UC and CD patients [11] [12]. Unlike previous studies, we found that age, prior fracture, disease duration, disease-associated inflammation, and smoking were not associated with bone loss.…”

Section: Discussioncontrasting

confidence: 99%

Bone Mineral Density in Patients with Newly Diagnosed Inflammatory Bowel Disease: Frequency and Risk Factors in Tunisian Population. Results of a Prospective Study

Cheikh¹,

Jomni²,

Bougassas³

et al. 2015

OJRA

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Background and Aims: Osteopenia and osteoporosis are frequently encountered with Inflammatory Bowel Disease (IBD). Our aims were to determine the prevalence of low bone mineral density (BMD) in patients with recently diagnosed IBD, and to assess predictive factors of reduced BMD. Patients and Methods: Prospective study conducted from January 2008 to December 2012 and involved patients with IBD treated in the Department of Gastroenterology of the Internal Security Forces Hospital. The data collected included: age, gender, body mass index (BMI), diagnostic delay, disease activity, and disease localization. Laboratory findings included serum calcium, phosphate, albumin, hemoglobin, and C-reactive protein. BMD was assessed by dual energy X-ray absorptiometry (DEXA) of the lumber spine and femoral neck. According to WHO criteria, osteopenia was defined as a T-score between −1 and −2 SD, and osteoporosis as a T-score less than −2 SD. Results: A total of 34 patients (17 men, 17 women) were enrolled. Mean age was 37.1 ± 13.8 years (range 16 -62). Twenty-two patients (65%) had Crohn's disease (CD) and 12 patients (35%) had ulcerative colitis (UC). Mean BMI was 20.5 ± 4 kg/m 2 . Low BMD occurred in 50% of patients (12 CD, 5 UC). Thirteen patients (38.2%) exhibited osteopenia and 4 patients (10.8%) showed osteoporosis. Mean vertebral T-score was −0.933 ± 1.41 (range −4.1 to 1.7) and BMD in this site was 1.079 ± 0.17 g/cm 2 (range 0.674 to 1.380). Mean femoral T-score was −0.398 ± 1.2 (range −3.1 to 2.4) and BMD in this site was 0.990 ± 0.173 g/cm 2 (range 0.633 to 1.600). There was a positive correlation between T-score and albuminemia. Low BMI was found to be predictive factor of reduced BMD at the * Corresponding author. M. Cheikh et al.127 moment of IBD diagnosis. However, no correlation was found between BMD and the other studied variables (age, gender, smoking, history of fracture, disease location, duration of disease, activity, small bowel resection, serum calcium level, phosphate, C-reactive protein and hemoglobin). Conclusion: Our study showed that the half of patients with IBD had a low BMD in newly diagnosed IBD patients. Low BMI and hypoalbuminemia were the major factors affecting BMD in these patients. Bone density measurement should be performed in all patients with IBD in an early stage of the disease.

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“…Estimates of osteopenia in IBD range from 31 to 59% and osteoporosis from 5 to 41%. Various studies exploring the cause of low BMD in IBD found a significant correlation between glucocorticoid treatment and decreased BMD (3,5,17,28,29). Glucocorticoids, such as prednisolone, are wellknown drugs for their potent anti-inflammatory and immunosuppressive properties.…”

mentioning

confidence: 99%

Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6

Huybers¹,

Naber²,

Bindels³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

102

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Huybers S, Naber TH, Bindels RJ, Hoenderop JG. Prednisolone-induced Ca 2ϩ malabsorption is caused by diminished expression of the epithelial Ca 2ϩ channel TRPV6. Am J Physiol Gastrointest Liver Physiol 292: G92-G97, 2007. First published August 10, 2006; doi:10.1152/ajpgi.00317.2006.-Glucocorticoids, such as prednisolone, are often used in clinic because of their anti-inflammatory and immunosuppressive properties. However, glucocorticoids reduce bone mineral density (BMD) as a side effect. Malabsorption of Ca 2ϩ in the intestine is supposed to play an important role in the etiology of low BMD. To elucidate the mechanism of glucocorticoid-induced Ca 2ϩ malabsorption, the present study investigated the effect of prednisolone on the expression and activity of proteins responsible for active intestinal Ca 2ϩ absorption including the epithelial Ca 2ϩ channel TRPV6, calbindin-D9K, and the plasma membrane ATPase PMCA1b. Therefore, C57BL/6 mice received 10 mg/kg body wt prednisolone daily by oral gavage for 7 days and were compared with control mice receiving vehicle only. An in vivo 45 Ca 2ϩ absorption assay indicated that intestinal Ca 2ϩ absorption was diminished after prednisolone treatment. We showed decreased duodenal TRPV6 and calbindin-D9K mRNA and protein abundance in prednisolone-treated compared with control mice, whereas PMCA1b mRNA levels were not altered. Importantly, detailed expression studies demonstrated that in mice these Ca 2ϩ transport proteins are predominantly localized in the first 2 cm of the duodenum. Furthermore, serum Ca 2ϩ and 1,25-dihydroxyvitamin D 3 [1,25(OH)2D3] concentrations remained unchanged by prednisolone treatment. In conclusion, these data suggest that prednisolone reduces the intestinal Ca 2ϩ absorption capacity through diminished duodenal expression of the active Ca 2ϩ transporters TRPV6 and calbindin-D 9K independent of systemic 1,25(OH)2D3.1,25-dihydroxyvitamin D3; duodenum; epithelial calcium channel 2; calcium transporter 1 REDUCED BONE MINERAL DENSITY (BMD) is particularly present in the elderly and women, which implies that age and gender are important risk factors for developing low BMD. However, in clinical practice low BMD is frequently observed in several patient groups, including inflammatory bowel disease (IBD) patients. Estimates of osteopenia in IBD range from 31 to 59% and osteoporosis from 5 to 41%. Various studies exploring the cause of low BMD in IBD found a significant correlation between glucocorticoid treatment and decreased BMD (3,5,17,28,29). Glucocorticoids, such as prednisolone, are wellknown drugs for their potent anti-inflammatory and immunosuppressive properties. As a consequence, glucocorticoids are widely used in clinic as drugs to treat inflammatory conditions such as IBD. To date, glucocorticoids are generally accepted to reduce BMD, despite the fact that in a number of studies an effect on bone mass could not be observed (5, 11) or could be observed only in male glucocorticoid users (31).This effect of glucocorticoids on BMD is caused by the c...

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Altered bone metabolism in inflammatory bowel disease: there is a difference between Crohn’s disease and ulcerative colitis

Cited by 173 publications

References 26 publications

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Bone Mineral Density in Patients with Newly Diagnosed Inflammatory Bowel Disease: Frequency and Risk Factors in Tunisian Population. Results of a Prospective Study

Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6

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Altered bone metabolism in inflammatory bowel disease: there is a difference between Crohn’s disease and ulcerative colitis

Cited by 173 publications

References 26 publications

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Vitamin D Status in Children and Young Adults With Inflammatory Bowel Disease

Bone Mineral Density in Patients with Newly Diagnosed Inflammatory Bowel Disease: Frequency and Risk Factors in Tunisian Population. Results of a Prospective Study

Prednisolone-induced Ca2+malabsorption is caused by diminished expression of the epithelial Ca2+channel TRPV6

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Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6