Bone Mineral Density and Body Composition in Ulcerative Colitis: A Six-Year Follow-up

Abstract

Reduced bone mineral density (BMD) has been reported in ulcerative colitis (UC), but there are no data concerning body composition (fat and lean mass) in such patients. We used whole body dual-energy X-ray absorptiometry (Hologic QDR 1000 W) at baseline and after 6 years of follow-up to study bone density, and fat and lean mass in 43 outpatients with mild UC (21 men, mean age 36 years, range 21-57 years, and 22 women, mean age 35 years, range 23-45 years at baseline; disease extent: 2 proctitis, 18 proctosigmoiditis, 8 left colitis, 5 substantial colitis, 10 pancolitis; mean disease duration 8 years, range 2-18 years; no hospitalization; few relapses during the follow-up) and 111 healthy volunteers matched by sex, age and body mass index. There were 5 drop-outs. We observed no significant difference in BMD, or fat and lean mass between the male patients and controls at baseline or after 6 years. The total lean mass (Z-score = -3.2, p = 0.001) and trunk lean mass (Z-score = -2.01, p = 0.03) of the female patients were lower than those of the controls at baseline, whereas their limb lean mass was higher at both the beginning and the end of the study (Z-score = 2.14, p = 0.03; Z-score = 2.8, p = 0.004, respectively). At baseline there was a significant negative correlation between lifetime steroid intake (enteral and parenteral) and lumbar spine BMD, obtained as whole body subregion (r = -0.53, p = 0.0006). After 6 years there was a significant negative correlation in women between whole body and lumbar spine BMD and both steroid intake (r = -0.53, p = 0.01; and r = -0.62, p = 0.003) and the number of relapses (r = -0.49, p = 0.02; and r = -0.44, p = 0.05). Mild UC thus does not represent a risk factor for osteopenia per se. The differences in lean mass between the female patients and controls do not seem to be clinically relevant.

Systematic review: body composition in adults with inflammatory bowel disease

“…BMD was found to negatively correlate with disease duration and inflammatory markers and to positively correlate with vitamin D levels . At longitudinal follow‐up in one study, female UC patients demonstrated a negative correlation with steroid use with regard to total body and lumbar spine BMD …”

“…In one study of UC patients, the female cohort was found to have reduced FFM compared with controls at baseline ( n = 22) . After 6‐year longitudinal follow‐up of this group of female patients, there was no significant decrease in total FFM compared with controls, as their limb FFM was found to have increased relative to baseline measurements …”

Bone mineral density in patients with inflammatory bowel disease: A population‐based prospective two‐year follow‐up study

“…Longitudinal studies on the rate of changes in bone mineral density (BMD) in IBD patients over time are few and have yielded conflicting results. Both increased bone loss and no significant changes in BMD during follow-up have been reported (4)(5)(6).…”

Associations among body composition, inflammatory profile and disease extent in ulcerative colitis patients

“…4,[22][23][24] Malnutrition is especially common in active UC patients after long-term hospitalization; 11,25 however, few studies have evaluated the nutritional status in patients with UC during remission. 4,12,26,27 Only one trial found a more compromised nutritional status (body weight and BMI) in UC patients during remission than in a control group. 28 In our study, we identified a low incidence of calorie malnutrition.…”