IBD and bone mineral disease

Oct 25, 2016 - E-Mentoring in IBD | Volume 9 • 2016

Issue 20

Clinical Question

What is the clinical course of bone mineral diseases (BMD) in patients with IBD over a 5-year interval?

Editor’s Bottom Line

At baseline, 60% of IBD patients have osteopenia or osteoporosis. Of the remainder with normal BMD, 20% will go on to develop BMD. Importantly, treatment maintains or improves BMD in the vast majority of these IBD patients.

Reference

Casals-Seoane F, Chaparro M, Maté J, et al. Clinical course of bone metabolism disorders in patients with inflammatory bowel disease: A 5-year prospective study. Inflamm Bowel Dis. 2016 Aug;22(8):1929–36. https://www.ncbi.nlm.nih.gov/pubmed/27135482

Synopsis

Consecutively enrolled adults with IBD were assessed at baseline and at 5 year follow-up for BMD via bone densitometry (T- and Z-scores). Socio-demographic status, clinical history, medications, smoking status, lifestyle, and dietary habits were assessed. Patients were grouped according to BMD findings at baseline: normal, osteoporosis, and osteopenia. Those with osteopenia were prescribed calcium (1000 mg/d) and vitamin D (800 IU/d); osteoporosis patients were referred to rheumatologists for bisphosphonate therapy. Regression analyses for each group were used to identify factors influencing BMD development and efficacy of baseline therapies.

At baseline, the average age of the cohort (n=100; 43 M: 57 F) was 41 years (CD: 42; UC: 58) and 60% were diagnosed with BMDs (osteopenia, 44%; osteoporosis, 16%). Only 58 patients (including 6 menopausal women) completed the 5 year follow-up of which 29% required steroids for disease flares. Within the normal BMD group (n=21), 4 developed osteopenia (P=0.047) which regression modeling found to be associated with age, smoking, and flares. In the osteopenia group (n=26), 6 (24%) had complete resolution, 19 (72%) did not worsen, and 1 (4%) developed osteoporosis. For those with osteoporosis at baseline (n=11), 6 (55%) improved to osteopenia.

Details

Study Design: Prospective, observational study
Funding: None
Allocation: Clinical features at baseline
Setting: Spain
Level of Evidence: 1b (Oxford Levels of Evidence)

The summary and conclusion in this issue of E-mentoring in IBD pertains to the manuscript(s) being reviewed, and should be considered in the context of what is already known surrounding the topic and incorporated into practice as deemed appropriate by the individual learner.