Inflammatory bowel disease and the risk of fracture after controlling for FRAX

Abstract

Subjects with inflammatory bowel disease (IBD) are at increased risk for hip and other major osteoporotic fractures. However, previous analyses have not fully accounted for differences in bone mineral density (BMD) and other clinical factors that affect the risk of fracture. The World Health Organization Fracture Risk Assessment tool (FRAX) can be used to predict the 10-year fracture risk from BMD and clinical risk factors. A population-based database containing clinical information on all IBD subjects in the province of Manitoba, Canada, was linked with the Manitoba Bone Mineral Density Database, which contains results of all dual X-ray absorptiometry (DXA) scans in the province. FRAX probabilities were calculated for all subjects aged 50 years or more undergoing baseline DXA testing. Subjects were followed for occurrence of major osteoporotic fractures (MOF; hip, clinical spine, wrist, humerus). Cox proportional hazards models were used to determine whether IBD was independently predictive of MOF or hip fracture. After controlling for FRAX fracture probability computed with BMD, IBD was not associated with a significantly increased risk for MOF (hazard ratio [HR] ¼ 1.12, 95% confidence interval [CI], 0.83-1.55) but was associated with an increased risk for hip fracture (HR ¼ 2.14; 95% CI, 1.26-3.65). The addition of femoral neck T-score to FRAX probability without knowledge of BMD had a negligible effect on the estimated HRs for IBD, suggesting that IBD mediates any effect on fracture risk independently of femoral neck BMD. After controlling for FRAX probability, subjects with IBD are not at an increased risk for overall MOF, but may be at increased risk of hip fracture. ß

Delays in Puberty, Growth, and Accrual of Bone Mineral Density in Pediatric Crohn’s Disease: Despite Temporal Changes in Disease Severity, the Need for Monitoring Remains

“…Given the requirement of sex steroids for normal bone mineralization, the absence of sex steroids during early adolescence is likely to worsen BMD accrual—the majority of which occurs during adolescence (33–36). Even though the low BMD in CD does not appear to contribute to an increase in fractures during childhood (31, 37), adults with CD persist with low BMD and have an increased fracture risk (38–40). …”

Obesity in Inflammatory Bowel Disease: Gains in Adiposity despite High Prevalence of Myopenia and Osteopenia

“…A deficit in bone mineral density (BMD) (osteoporosis/osteopenia) is one of the most common complications of IBD, and has been reported in 20% to 50% of patients [ 21 , 22 , 23 ]. Reduced BMD is associated with an increased risk of pathological fractures and associated morbidity [ 22 , 24 ].…”

“…A deficit in bone mineral density (BMD) (osteoporosis/osteopenia) is one of the most common complications of IBD, and has been reported in 20% to 50% of patients [ 21 , 22 , 23 ]. Reduced BMD is associated with an increased risk of pathological fractures and associated morbidity [ 22 , 24 ]. The pathogenesis of metabolic bone disease in IBD is likely multifactorial; however, clinical data are lacking, and the influence of IBD-related factors beyond conventional risk factors remains poorly explored [ 25 , 26 ].…”

MANAGEMENT OF ENDOCRINE DISEASE: Secondary osteoporosis: pathophysiology and management

“…Disease severity correlates with fracture risk even after adjusting for corticosteroid use. The risk of fractures is higher in Crohn’s disease than in ulcerative colitis (121) .…”