Bone Metabolism Alteration in Patients with Inflammatory Bowel Disease

Abstract

Background: Metabolic bone disease is a common disorder, but there is a lack of data on it in patients with inflammatory bowel disease (IBD). Methods: In this prospective, one-centre study, we assessed bone mineral and vitamin D alterations in 187 IBD patients (119 with Crohn’s disease (CD) and 68 with ulcerative colitis (UC)). Results: While 81.3% of the patients had vitamin D deficiency, 14.2% of them had a severe deficiency. Elevated serum PTH concentrations were found in 14.9% of the patients. Only in 4.1% of cases was there an elevated level of a serum marker for bone formation (osteocalcin), whereas in 14.4% of cases, the bone resorption marker (CTX) was raised. The concentration of phosphate in urine was higher in the CD than in the UC group (51.20 vs. 31.25; p = 0.003). PTH was negatively associated with vitamin D level. Among the patients receiving corticosteroids, the CTX and CRP median levels were higher (0.49 vs. 0.38; p = 0.013 and 6.45 vs. 2.2; p = 0.029, respectively) compared with the group who did not receive them. Urine phosphate levels were lower (48.60 vs. 26.00; p = 0.005), as were osteocalcin (15.50 vs. 23.80; p < 0.001), and PTH (29.05 vs. 36.05; p = 0.018). Conclusions: Bone mineral alterations were common in patients with IBD, mostly in the CD patients. This may be associated with poor absorption, making CD patients vulnerable to changes in bone mineralization. Vitamin D supplementation remains crucial, especially when taking corticosteroids.

Measurement of Calprotectin and PTH in the Amniotic Fluid of Early Second Trimester Pregnancies and Their Impact on Fetuses with Growth Disorders: Are Their Levels Related to Oxidative Stress?

“…This may indicate the influence of inflammation on bone mineral alterations [63]. Patients with inflammatory bowel disease, mainly those with Crohn's disease, are at high risk for bone mineral modifications due to augmented cytokine release [64].…”

Pivotal Role of Intestinal Microbiota and Intraluminal Metabolites for the Maintenance of Gut–Bone Physiology

“…IBD has been associated with decreased bone mass and alterations in bone geometry from the time of diagnosis, frequently before the initiation of anti-inflammatory therapy. Bone disease is attributed to vitamin D deficiency, steroid use and/or systemic inflammation [ 119 ]. IBD patients are at higher risk for developing osteoporosis and osteopenia than the general population, with a 40% higher relative risk of fracture in IBD patients [ 120 , 121 , 122 ].…”

“…Accordingly, in almost 15% of IBD patients that were analyzed in a prospective, single center study, markers for bone resorption, such as the C-terminal telopeptide of type 1 collagen (CTX), were increased. Bone mineral alterations were common in IBD patients and Vitamin D supplementation was found to be crucial, especially when taking corticosteroids, azathioprine and/or infliximab [ 119 ]. Interestingly, the severity (but not the activity) of disease was associated with osteopenia in IBD patients [ 128 , 129 , 130 ].…”