Bone density improves with disease remission in patients with inflammatory bowel disease

The Gastrointestinal Laboratory, The Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK.
European Journal of Gastroenterology & Hepatology (Impact Factor: 2.25). 01/2004; 15(12):1267-73. DOI: 10.1097/01.meg.0000085510.01212.57
Source: PubMed


Patients with inflammatory bowel disease (IBD) are at risk of low bone mineral density (BMD). The aim of this cross-sectional study was to investigate (i) whether patients with IBD in long-term remission have greater bone density relative to patients with active disease, (ii) the effect of remission on BMD in ulcerative colitis and Crohn's disease, and (iii) the effect of azathioprine treatment, used to induce remission, on BMD.
BMD relative to the age-standardised mean (Z-score) was measured by dual-energy X-ray absorptiometry at the left femoral neck and lumbar spine in consecutive patients with IBD. Patients were divided into the following groups: (i) active disease, (ii) remission of less than one year, (iii) remission of one to three years, and (iv) remission of more than three years. Active disease was defined as three or more bowel motions per day, treatment with oral or rectal corticosteroids, and/or presence of a fistula. The subgroups with ulcerative colitis and Crohn's disease and the effect of taking azathioprine were compared. All results were controlled for confounding variables. RESULTS A total of 137 (64 ulcerative colitis, 73 Crohn's disease) patients were evaluated. Patients in remission for more than three years had a normal mean Z-score that was significantly higher than those with active disease at both the femoral neck and the lumbar spine for both ulcerative colitis and Crohn's disease. Patients taking azathioprine and in remission had significantly higher mean Z-scores at the lumbar spine than patients with active disease and who were not taking azathioprine.
In patients with ulcerative colitis and Crohn's disease, age-matched BMD is higher with increasing duration of disease remission and induction of remission by azathioprine.

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    ABSTRACT: Most studies have shown contradictory results regarding predictive factors of osteoporosis in inflammatory bowel disease (IBD). Since in these studies either T- or Z-scores has been used, our aim was to compare T- and Z-score in identifying risk factors of osteoporosis in IBD patients. Bone density was measured by dual X-ray absorptiometry (DXA) at L2-L4 of the spine and femoral neck in 122 patients. Twenty-two clinical parameters were recorded prior to DXA and evaluated by univariate and multivariate analysis. On multivariate analysis, cumulative steroid dose was a predictive factor of femoral neck T-score (p<0.001) and Z-score (p=0.001). Age was a predictive factor of femoral neck T-score (p<0.001). BMI was a predictive factor of femoral neck Z-score (p=0.03). None of the other 19 variables tested had any predictive value for bone density. Age >or=55 years was a risk factor of low femoral neck T-score (OR 5.08, 95% CI 1.90-13.57, p=0.001), as was cumulative dose of prednisolone >or=5 g (OR 3.41, 95% CI 1.50-7.73, p=0.004). There is a discordance of results depending on whether T- or Z-scores are used in analysis. Among 22 parameters, cumulative steroid dose and age proved to be the most important factors.
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    Eser A ·

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    ABSTRACT: Bei chronisch entzündlichen Darmerkrankungen sind Osteopenie und Osteoporose häufige und für den Patienten oft unterschätzte extraintestinale Komplikationen. Unsere Studie zeigt den auffällig hohen Anteil an verminderter Knochendichte bei Morbus Crohn Patienten. 173 (43,7 Prozent) der 397 Patienten weisen eine Osteopenie und 18,7 Prozent (n = 74) eine Osteoporose auf. Insgesamt haben 62,4 Prozent der Patienten (n = 247) eine pathologische Knochendichte. Bei unseren Patienten mit Morbus Crohn konnten Laktoseintoleranz (p = 0,000001), das männliche Geschlecht (p = 0,007), das Auftreten von Stenosen (p < 0,0025) bzw. Fisteln (p < 0,00036) und der body mass index (p < 0,004) als Risikofaktoren für eine verminderte Knochendichte festgestellt werden. Die Bedeutung der Malabsorption in der Entstehung verminderter Knochendichte bei Patienten mit Morbus Crohn wird durch den hohen Anteil an Patienten mit niedrigem body mass index, Lactoseintoleranz, Stenosen, Fisteln und mehrfachen Darmresektionen in der Osteoporosegruppe unserer Studie unterstrichen. Unsere Studie bestätigt die hohe Prävalenz der Osteopenie und Osteoporose bei an Morbus Crohn erkrankten Patienten. Deshalb sollte bei allen Patienten mit Morbus Crohn und der Anwesenheit von aktuell bekannten Risikofaktoren eine Knochendichtemessung durchgeführt werden, der eine entsprechende Osteoporoseprophylaxe bzw. -therapie folgen muss.
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