Inflammatory Bowel Disease and Risk of Osteoporotic Fractures: A Meta-Analysis

Abstract

IntroductionInflammatory bowel disease (IBD) and its complications have been well-established. The literature shows an association between IBD and decreased bone mineral density in the adult population. However, most studies have reported an association between IBD and osteoporosis, while the risk of fractures has not been well-studied. The aim of this meta-analysis is to summarize the best available evidence regarding IBS and osteoporotic fractures.MethodsA review of the literature using the MEDLINE and EMBASE databases was performed during November 2017. We included cross-sectional and cohort studies that reported the relative risks, odds ratios, and hazard ratios comparing the risk of developing osteoporotic fractures among patients with IBD patients, both ulcerative colitis (UC) and Crohn’s disease (CD), versus patients without IBD as controls. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using the generic inverse-variance method.ResultsAfter a review of the literature, seven studies fulfilled the eligibility criteria established during the analysis. A significant association was found between IBD and osteoporosis, with a pooled OR of 1.32 (95% CI, 1.2 - 1.4). Low heterogeneity among the studies was found, I2=42.3. No publication bias was found using the Egger regression test p=0.18. Sensitivity analysis showed that the inclusion of data on children by Kappelman et al. (2007) did not change the results.ConclusionA significant association between IBD and the risk of developing osteoporotic fractures was observed in this study. There is a 32% increased risk, which is consistent with different cohort studies previously done.

Differences in Dietary Patterns of Adolescent Patients with IBD

“…Moreover, studies estimated that as many as 77% of patients with IBD have osteopenia and 12–41% have osteoporosis [ 41 , 45 ]. The risk of osteoporosis and osteopenia among patients with IBD is also related to insufficient intake and absorption of calcium and potassium, lower body mass index (BMI) and insufficient physical activity, low peak bone mass, and certain medications, especially glucocorticosteroids [ 46 , 47 ]. Adequate calcium intake is crucial due to IBD’s association with an increased incidence of osteoporosis, and additionally, during ongoing inflammation, pro-inflammatory cytokines affect the activity of bone cells [ 42 ].…”

Chronic Liver Disease and the Risk of Osteoporotic Fractures: A Meta-Analysis

“…Cochran's Q test and I2 statistic were used to determine the between-study heterogeneity. A value of I2 of 0%-25% represents insignificant heterogeneity, greater than 25% but less than or equal to 50% represents low heterogeneity, greater than 50% but less than or equal to 75% represents moderate heterogeneity, and greater than 75% represents high heterogeneity [14,15].…”

“…Early detection and lifestyle modification could potentially decrease the risk of osteoporosis and hence the fractures in patients with CLD. This work has been presented as an abstract [ 29 ].…”

“…The Newcastle-Ottawa scale ( Figure 1) was used by the investigators independently to determine the quality of each study. This scale evaluates each study in terms of participants selection (minimum score is 0; maximum is 4), comparability (minimum score is 0; maximum is 2), and the ascertainment of the exposure of interest for case-control studies, and the outcome of interest for cohort studies (minimum score is 0; maximum is 3) [13,14,15]. Newcastle-Ottawa scale contains eight items within three domains and the total maximum score is 9.…”

Assessment of bone quality with trabecular bone score in patients with inflammatory bowel disease

“…Decreased bone mineral density (BMD) could lead to fragility fractures. In a recent meta-analysis, Hidalgo 2 found that patients with IBD have a 32% increased risk of developing an osteoporotic fracture, more commonly in the vertebral area 3 .…”