Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

Abstract

Osteomyelitis and osteonecrosis are skeletal disorders seen in patients with inflammatory bowel disease (IBD). Osteomyelitis usually occurs in the pelvic bones, especially in complicated Crohn's disease, presumably by direct extension from a pelvic inflammatory mass, abscess or fistulous tract. Diagnosis of osteomyelitis may be difficult and can lead to spinal extension of the septic process with a resultant neurological deficit, including paraplegia. Osteonecrosis or avascular necrosis has been reported in patients with either ulcerative colitis or Crohn's disease, often, but not exclusively, during or following steroid treatment. The disease is often multifocal, but its natural history is unknown, especially if diagnosed early with modern imaging methods, such as magnetic resonance. In IBD patients, the relationship between osteonecrosis and steroid use is unknown. An adverse steroid effect on bones, especially the femoral heads, may develop in some patients with IBD but, to date, this hypothesis remains unproven. Critical evaluation of published data reveals no consistent association between osteonecrosis and steroid treatment in IBD patients.

Avascular necrosis of the knees and ulcerative colitis

“…The condition is found most commonly in the femoral head, but in some cases it is a multifocal process (2). The overall rate of AN in Crohn's disease patients is estimated at 0,5% (3), but the incidence in ulcerative colitis patients would be much lower.…”

“…However, today it is recognized that IBD predispose patients to AN. Some studies suggest that IBD lowers the threshold of corticosteroids (lower doses per day and for shorter time) needed to induce AN (2,5). Also, AN may occur in patients with IBD who have not received any corticosteroid therapy (1) suggesting that other pathogenic factors must be involved, such as hypercoagulability (5) or parenteral nutrition with infused lipids (7).…”

Chronic multifocal osteomyelitis: Is infectious causation a moot point?

“…One case report noted possible progression to B cell lymphoma [60], while another report found CMO to evolve after completing treatment for acute lymphocytic leukemia [61]. Table 3 outlines several associations of CMO with other disease entities [12,13,18,23,39,47,56,[62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80]. Many of these associations are inclusive of entities which would be considered by many to be immune phenomena.…”

Rezidivierende aseptische Knochennekrosen bei Morbus Crohn - Extraintestinale Manifestation oder Steroid-assoziierte Komplikation?

“…Dennoch gelten der Morbus Crohn und die Colitis ulcerosa als Risikofaktor für aseptische Knochennekrosen. Sie werden in Verbindung mit einer Steroidtherapie, aber auch ohne eine solche beschrieben (1)(2)(3)(4)(5)(6)(7)(9)(10)(11)(12)(13)(14). Bis heute ist unklar, ob aseptische Knochennekrosen nicht eine seltene extraintestinale Manifestation der chronisch entzündlichen Darmerkrankung sind.…”