BACKGROUND: Crohn's disease impacts the bone health of patients and results in a high prevalence of low bone mineral density (BMD) disease such as osteoporosis and osteopenia. Bisphosphonates can reduce bone loss by inhibiting bone resorption. AIM: To assess the effectiveness and safety of bisphosphonates for osteoporosis or osteopenia in Crohn's disease. METHODS: A literature search included PubMed, EMBASE, the Science Citation Index, and the Cochrane Library was conducted to identify studies up to March, 2012. Randomized controlled trials (RCTs) comparing bisphosphonates with placebo or no intervention for osteoporosis or osteopenia in adult patients with Crohn's disease were analyzed. RESULTS: Five RCTs involving 423 participants were included. All patients received daily calcium and vitamin D supplementation. Overall, bisphosphonates improved hip BMD at 12 months (n = 193, MD = 0.99, 95 % CI: 0.14-1.84) compared with placebos or no intervention. No significant differences of spine BMD at both 12 months (n = 193, MD = 1.78, 95 % CI: -0.99 to 4.55) and 24 months (n = 231, MD = 0.70 %, 95 % CI: -0.48 to 1.88), hip BMD at 24 months (n = 231, MD = 0.25 %, 95 % CI: -0.65 to 1.15), new vertebral fractures (n = 117, RD = -0.01, 95 % CI: -0.08 to 0.05) or adverse events (n = 422, RR = 1.03, 95 % CI: 0.71-1.49) between bisphosphonates groups and control groups were noted. Subgroup analyses of participants treated with corticosteroid in the preceding year found no difference between two groups. CONCLUSIONS: There was no evidence to support the use of bisphosphonates for osteoporosis or osteopenia in Crohn's disease. More randomized controlled clinical trials assessing the effects of bisphosphonates are needed.
[Show abstract][Hide abstract] ABSTRACT: Children with chronic illnesses such as Juvenile Idiopathic Arthritis and Crohn's disease, particularly when taking glucocorticoids, are at significant risk for bone fragility. Furthermore, when childhood illness interferes with achieving normal peak bone mass, life-long fracture risk is increased. Osteopenia and osteoporosis, which is increasingly recognized in pediatric chronic disease, likely results from numerous disease- and treatment-related factors, including glucocorticoid exposure. Diagnosing osteoporosis in childhood is complicated by the limitations of current noninvasive techniques such as DXA, which despite its limitations remains the gold standard. The risk:benefit ratio of treatment is confounded by the potential for spontaneous restitution of bone mass deficits and reshaping of previously fractured vertebral bodies. Bisphosphonates have been used to treat secondary osteoporosis in children, but limited experience and potential long-term toxicity warrant caution in routine use. This article reviews the factors that influence loss of normal bone strength and evidence for effective treatments, in particular in patients with gastrointestinal and rheumatologic disorders who are receiving chronic glucocorticoid therapy.
Current Osteoporosis Reports 07/2014; 12(3). DOI:10.1007/s11914-014-0228-x
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