Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease.

Motley, Richard; Crawley, E.O.; Evans, Carol; Rhodes, J.; Compston, Juliet

doi:10.1136/gut.29.10.1332

Cited by 85 publications

(39 citation statements)

References 19 publications

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“…With respect to steroids, the deleterious effects of corticosteroids on trabecular bone mass are well documented in some studies, but conflicting evidence comes from longitudinal and cross-sectional studies 5,20,25,27,28 that failed to show any correlation between the rate of bone loss and steroid use. In a previous study, decreased bone mass was already present at the time of diagnosis 29 in patients with CD.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for metabolic bone disease in Crohnʼs disease patients

Cravo

Guerreiro

Santos

et al. 2010

Inflammatory Bowel Diseases

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Section: Discussionmentioning

confidence: 99%

Risk factors for metabolic bone disease in Crohnʼs disease patients

Cravo

Guerreiro

Santos

et al. 2010

Inflammatory Bowel Diseases

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“…2 Low BMD has also been reported in 31±39% of patients with in¯ammatory bowel disease in cross-sectional and prospective studies. 1,3,5,18 The mechanism of osteopenia in in¯am-matory bowel disease is not understood, but the results suggest that there is low bone formation, in spite of normal calcium levels and the normal levels of calcium regulating hormones. Vitamin D de®ciency is not an important contributor to osteopenia.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The osteoporosis seen in female patients with Crohn's disease can be prevented by sex hormone replacement therapy (HRT). 5,6 Jejunoileal bypass surgery has been performed for morbid obesity and, more recently, for hyperlipidaemia. By the 1980s it was estimated that, worldwide, many tens of thousands of operations had been performed.…”

Section: Introductionmentioning

confidence: 99%

Reduced bone mineral density after surgical treatment for obesity

et al. 1999

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OBJECTIVE: To investigate whether osteoporosis occurs after surgical treatment for obesity. DESIGN: A cross-sectional study of ®ve groups of subjects who had undergone surgical treatment for obesity: ®ve premenopausal women; 13 post-menopausal women; seven post-menopausal women taking oestrogen replacement (HRT); ®ve men; and six women who had undergone surgical reversal (mean time 7 y). SUBJECTS: Thirty-six Caucasian subjects who had undergone jejunoileal or pancreaticobiliary bypass surgery at St George's Hospital between 1971 and 1992. Their mean age was 50.8 y (range 32 ± 69 y) and the median time since the operation was 14.8 y (range 4 ± 23 y). MEASUREMENTS: A clinical questionnaire was used to exclude possible factors, which might in¯uence bone mineral density. A single blood sample was collected for measurement of calcium, phosphate, alkaline phosphatase, albumin, magnesium, zinc, creatinine, thyroxine, 25-hydroxy-vitamin D, sex steroids, gonadotrophins and IGF-1 and 24 h urine calcium excretion was measured. Bone mineral density (BMD) was measured in the lumbar (L2-L4) spine (LS) and femoral neck (FN) by dual energy X-ray absorptiometry (DEXA). RESULTS: There was no difference in serum calcium, alkaline phosphatase, IGF-1, 25-hydroxy-vitamin D (25-OH vitamin D), magnesium or zinc concentrations between the ®ve groups. The LS-BMD T score was lower (P`0.05) in male subjects ( 7 2.08 AE 1.04 mean 1.0 AE s.d) and post-menopausal women not taking HRT ( 7 1.21 AE 1.33) compared to the surgically reversed group (0.87 AE 2.36). The male group was most severely affected, despite normal serum testosterone concentrations. Two of the ®ve men studied, had a LS-BMD T score`7 2.5 and two had a LS-BMD T score between 7 1.0 and 7 2.5. In contrast, six of the seven post-menopausal women on HRT had an LS BMD T score b 7 1.0. There was no difference in the FN-BMD between the ®ve groups. The presence of low BMD was not related to age, duration of bypass, or degree of postoperative weight loss. Iliac crest bone biopsies in three subjects with low BMD, con®rmed the presence of osteoporosis. CONCLUSIONS: Reduced bone mineral density is a complication of jejunoileal bypass surgery.

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“…These findings suggest that CD itself plays an important role in the development of osteopenia/osteoporosis, and that a low BMD cannot be attributed solely to treatment with steroids. Corticosteroids have been shown to reduce the BMD [2,9,10,11,12,13,14,15,16], although the data are conflicting [5, 6,17,18,19,20,21]. …”

Section: Introductionmentioning

confidence: 99%

Analysis of Risk Factors for Low Bone Mineral Density in Inflammatory Bowel Disease

et al. 2006

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Background/Aim: Several risk factors have been suggested for osteoporosis which frequently occurs in inflammatory bowel disease (IBD) patients. We studied prevalence and risk factors for reduced bone mineral density (BMD) in IBD patients at the University Hospital of Zürich, Switzerland. Methods: The BMD was determined by dual-energy X-ray absorptiometry at the lumbar spine and femoral neck in 88 IBD patients (55 with Crohn’s disease, 30 with ulcerative colitis, and 3 with indeterminate colitis). Z scores were obtained by comparison with age- and sex-matched normal values, and T scores by comparison with sex-matched healthy young adults. Osteopenia and osteoporosis were defined according to the WHO guidelines. Predictive factors for BMD were analyzed by group comparison and stepwise regression analysis. Results: Osteopenia was present in 43% of the patients at the lumbar spine and in 42% of them at the femoral neck. Osteoporosis was present in 14% of the patients at the lumbar spine and in 5% of them at the femoral neck. At the lumbar spine, stepwise regression analysis showed that body mass index, age, number of bowel resections, topic steroids, and azathioprine correlated with the Z scores. Cumulative steroid dose, topic steroids, age and bowel resection were found to be predictors for a pathological T score. At the femoral neck, regression analysis showed that body mass index, age, topic steroids, and azathioprine correlated with the Z scores. Only a low body mass index was a significant predictor for pathological femoral T scores. Conclusions: Osteopenia and osteoporosis are commonly found in IBD patients. Steroid treatment and bowel resection were significant risk factors for osteoporosis of the lumbar spine. However, disease-inherent factors also appear to confer a major risk, indicating that the BMD should be determined in all IBD patients, irrespective of steroid treatment.

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Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease.

Cited by 85 publications

References 19 publications

Risk factors for metabolic bone disease in Crohnʼs disease patients

Risk factors for metabolic bone disease in Crohnʼs disease patients

Reduced bone mineral density after surgical treatment for obesity

Analysis of Risk Factors for Low Bone Mineral Density in Inflammatory Bowel Disease

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