Reduced bone formation in patients with osteoporosis associated with inflammatory bowel disease

Abstract

The pathophysiology of bone loss associated with inflammatory bowel disease has not been clearly defined. In this study we have performed a detailed histomorphometric analysis of iliac crest bone obtained from 19 patients with inflammatory bowel disease in whom a diagnosis of osteoporosis had been made. Eleven subjects were receiving prednisolone at the time of their biopsy. Comparison with control values demonstrated a highly significant reduction in trabecular bone area in the patient group (p < 0.001). Wall width, adjusted appositional rate and bone formation rate were all significantly reduced in the patient group (p < 0.001) and the formation period was significantly increased (p < 0.001). Resorption cavities were slightly smaller in the patient group, differences in maximum cavity depth and cavity length achieving statistical significance (p < 0.005 and p < 0.05 respectively). The mineral appositional rate was significantly reduced in the patients with inflammatory bowel disease (p < 0.001) and the mineralization lag time significantly increased (p < 0.001); however, osteoid area, perimeter and seam width were not significantly different from controls. These results demonstrate that osteoporosis associated with inflammatory bowel disease is characterized by reduced bone formation at the cellular and tissue level; the proportionately greater change in wall width than in resorption cavity depth is consistent with a negative remodelling balance. Although none of the patients had osteomalacia as defined by the criteria of increased osteoid seam width and mineralization lag time, the higher mineralization lag time in the patient group indicates a mild mineralization defect.

Reduced bone mineral density after surgical treatment for obesity

“…2 In Crohn's disease, the situation may be complicated by the administration of oral glucocorticoids, but is not entirely steroidrelated. 3,4 The osteoporosis seen in female patients with Crohn's disease can be prevented by sex hormone replacement therapy (HRT). 5,6 Jejunoileal bypass surgery has been performed for morbid obesity and, more recently, for hyperlipidaemia.…”

Natural history of bone metabolism and bone mineral density in children with inflammatory bowel disease

“…Most reports in adults with IBD suggest that bone loss results is due to increased bone resorption, 8 -11 while others have reported decreased bone formation relative to bone resorption. 12 In developing children it is likely that IBD primarily affects bone formation and modeling, but this has not been studied.…”

Iliac bone histomorphometry in children with newly diagnosed inflammatory bowel disease

“…Histomorphometric studies on adult IBD patients have shown that both osteomalacia and osteoporosis can occur following small bowel resection [11,12]. In adults who suffered from osteoporosis in the context of long-standing IBD, a markedly low trabecular bone volume and a negative remodeling balance on trabecular bone surfaces were found [13]. However, to our knowledge, histomorphometric data are not available for pediatric IBD or for newly diagnosed IBD in either children or adults.…”

“…This is somewhat surprising, as histomorphometric studies in adults who suffered from osteoporosis in the context of IBD have revealed markedly low trabecular bone volume [13]. Similarly, animal models of IBD are characterized by a decrease in the amount of trabecular bone after induction of IBD, at least in mature animals [32,33].…”