Prediction of low bone mineral density in patients with inflammatory bowel diseases

Abstract

Background: Low bone mineral density (BMD) remains a frequent problem in patients with inflammatory bowel diseases (IBD). There is no general agreement regarding osteoporosis screening in IBD patients. Methods: Cases of low BMD and disease characteristics were retrieved from 3172 patients of the Swiss IBD cohort study. Multivariate logistic regression analysis was conducted for predictive modeling. In a subgroup of 877 patients, 253 dualenergy X-ray absorptiometry (DXA) scans were available for validation. Results: Low BMD was prevalent in 19% of patients. We identified seven predictive factors: type of IBD, age, recent steroid usage, low body mass index, perianal disease, recent high disease activity and malabsorption syndrome. Low BMD could be predicted with a sensitivity of 79% and a specificity of 64%, a positive predictive value (PPV) of 35% and a negative predictive value (NPV) of 93%. The area under the curve of the receiver operating characteristics was 0.78. In the validation cohort we calculated a PPV of 26% and an NPV of 88%. Conclusion:We provide a comprehensive analysis of risk factors for low BMD and propose a predictive model with seven clinical variables. The high NPV of models such as ours might help in excluding low BMD to prevent futile investigations.

Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study

“…[22] For the calculation of the Activity Index, disease activity was normalized to a parameter ranging from 0 (no activity) to 100 (strongest activity). Thereby, for CD patients the Crohn disease activity index was divided by 5; for ulcerative colitis/indeterminate colitis patients the modified Truelove and Witts severity index was divided by .21.…”

Risk Factors for Low Bone Density in Inflammatory Bowel Disease: Use of Glucocorticoids, Low Body Mass Index, and Smoking

“…Bone density measurements were performed in 3 sites: femoral neck, total hip, lumbar spine using a Hologic densitometer (Hologic Inc., Bedford, MA, USA). Decreased bone density was defined as Z score <-2, at any of the 3 sites [2,14].…”

“…Dig Dis 2019;37:284-290 DOI: 10.1159/000496935 quent fractures are major causes of immobility and a decrease in the quality of life among IBD patients [2]. Among the possible contributing factors for low bone density in IBD are malabsorption, malnutrition, glucocorticoid treatment, low body mass index (BMI), and coexisting comorbidities [3].…”

Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people

“…However, steroids are limited by dose-and duration-dependent adverse effects such as osteoporosis and sarcopenia, contributing to frailty and loss of autonomy among senior patients. In Swiss IBD patients, steroids (OR 4.4) and age (OR 1.03 per year) were the most relevant risk factors for decreased bone mineral density [17,58].…”

“…Osteoporosis and osteoporotic fractures are increased by 40-60% in IBD patients [84,85]. Senior IBD patients are at increased risk of osteoporosis and related fractures due to malnutrition, vitamin D deficiency and reduced physical activity [58,86]. Given this risk profile in addition to age-related bone loss, Dual Energy X-ray Absorptiometry (DXA)-screening among senior IBD patients with steroid exposure and/or additional risk factors is recommended [52,86].…”