Risk factors for osteoporosis in inflammatory bowel disease patients

Abstract

Inflammatory bowel disease (IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density (BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn's disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored.

Emerging Roles for Noncanonical NF-κB Signaling in the Modulation of Inflammatory Bowel Disease Pathobiology

“…Indeed, bone loss is not uncommon in patients with chronic IBD, along with a variety of concurrent risk factors being identified including corticosteroid use, smoking, and vitamin D deficiency. Interestingly, treatment with infliximab is associated with improvements in bone metabolism (42). The exact mechanism linking RANKL/RANK/OPG, mucosal immunology, and bone remodeling has been investigated in several mouse models.…”

Improving bone mineral density screening in patients with inflammatory bowel disease: a quality improvement report

“…While some evidence suggests that patients with IBD inherently have a greater risk for bone mineral disease, the pathogenesis is likely multifactorial. Increased production of inflammatory cytokines, malabsorption of vitamin D and calcium, and frequent glucocorticoid use are all known to play a role 4. Of these risk factors, the use of oral glucocorticoids has been shown to be predictive of increased fracture risk 5…”

Expression of Cav1.3 calcium channel in the human and mouse colon: posttranscriptional inhibition by IFNγ

“…rosis in IBD is complex and multifactorial and includes malnutrition, malabsorption, low body mass index, use of corticosteroids, smoking, increasing age, and the type of IBD (Crohn's disease vs. ulcerative colitis) (15,22). One of the possible mechanisms contributing to bone loss in IBD is impaired mineral homeostasis either from decreased intestinal absorption and/or low renal reabsorption of calcium, thus creating a negative Ca 2ϩ balance.…”