Predictors of risk of fracture in inflammatory bowel diseases: a prospective study using FRAX score

Abstract

BACKGROUND: Despite the well-known risk of osteoporosis and bone fractures among patients with inflammatory bowel diseases, the WHO FRAX tool has been used in a limited number of studies in this specific population. The purpose of this study was to search for predictors of risk of fractures assessed by FRAX score. METHODS: We prospectively calculated FRAX score for hip and major osteoporotic fractures in inflammatory bowel disease patients consecutively recruited. RESULTS: The mean risk of hip fractures at 10 years, for the 80 recruited patients, resulted 1.4%, while the mean risk of major osteoporotic fractures was 7.8%. The risk of hip fractures was 1.3% among the 30 Crohn's disease patients versus 1.4% (p = 0.82) among 50 ulcerative colitis patients. A prolonged use of corticosteroids correlated with a tendency to a greater risk of hip fracture (r = 0.38, p = 0.08). Patients with normal erythrocyte sedimentation rate (ESR) values had a risk of osteoporotic hip fractures of 0.75%, while those with high ESR values had a risk of 1.86% (p = 0.04). Regarding the risk of major bone fractures, patients with normal ESR values had a risk of 5.9%, versus a risk of 18% in those with elevated ESR (p = 0.03).CONCLUSIONS: The correlation between increase of inflammatory markers and increased risk of osteoporotic fractures and the lack of difference between Crohn's disease and ulcerative colitis suggest a central role of inflammation over malabsorption in this population.

Body Composition as a Modulator of Bone Health Changes in Patients with Inflammatory Bowel Disease

“…Visceral adipose tissue (VAT), the "creeping fat" [15], has been considered to be highly relevant in IBD patients, especially in CD, as it is an important secreting site of mesenteric adipocytes, releasing proinflammatory cytokines, such as TNFα. Chronic inflammation has been associated with increased risk for osteoporotic fractures in IBD patients [16]. Whether assessed through imaging techniques (CT, MRI and DXA), or estimated by means of waist circumference, VAT has been widely reported as a negative predictor for bone quality [17][18][19][20][21][22].…”