Clin Endosc.  2013 Jan;46(1):71-76. 10.5946/ce.2013.46.1.71.

The Early Onset of Disease May Be a Risk Factor for Decreased Bone Mineral Density in Patients with Inflammatory Bowel Disease

Affiliations
  • 1Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea. sjhong@schmc.ac.kr
  • 2Department of Nutrition, Soonchunhyang University College of Medicine, Bucheon, Korea.
  • 3Department of Pathology, Soonchunhyang University College of Medicine, Bucheon, Korea.

Abstract

BACKGROUND/AIMS
The pathogenesis of bone loss in patients with inflammatory bowel disease (IBD) is complex, multifactorial, and only partly understood. We aimed to examine the extent and risk factors of bone mass reduction and to analyze the impact of early onset of a disease before attaining peak bone mass in IBD patients.
METHODS
We compared the risk factors for osteoporosis and BMD at the lumbar spine and the hip bone in IBD patients.
RESULTS
A total of 44 patients with IBD were enrolled. Twenty-one and 23 patients were diagnosed as IBD before and after the age of 30 and designated as group A and group B, respectively. Group A had significant bone mass reduction at the lumbar spine than group B (BMD, 1.01+/-0.10 vs. 1.14+/-0.17, p<0.01; T-score, -1.22+/-0.84 vs. -0.08+/-1.39, p<0.01; Z-score, -1.11+/-0.81 vs. -0.03+/-1.32, p<0.01, respectively). Multivariate analysis showed that patients diagnosed as IBD before the age of 30 had possible risk factor of bone mass reduction (hazard ratio, 3.96; p=0.06).
CONCLUSIONS
Bone mass reduction was more severe in patients who were diagnosed with IBD before the age of 30 than in those diagnosed after the age of 30.

Keyword

Inflammatory bowel diseases; Bone density; Steroids; Age

MeSH Terms

Bone Density
Hip
Humans
Inflammatory Bowel Diseases
Multivariate Analysis
Osteoporosis
Risk Factors
Spine
Steroids
Steroids

Cited by  1 articles

Can Early Onset of Disease Be One of the Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease?
Kwang An Kwon, Yang Suh Ku
Clin Endosc. 2013;46(1):5-6.    doi: 10.5946/ce.2013.46.1.5.


Reference

1. Bernstein CN, Leslie WD. Review article: osteoporosis and inflammatory bowel disease. Aliment Pharmacol Ther. 2004; 19:941–952. PMID: 15113361.
2. Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009; 122:599–604. PMID: 19559158.
Article
3. Vestergaard P. Bone loss associated with gastrointestinal disease: prevalence and pathogenesis. Eur J Gastroenterol Hepatol. 2003; 15:851–856. PMID: 12867793.
4. Moschen AR, Kaser A, Enrich B, et al. The RANKL/OPG system is activated in inflammatory bowel disease and relates to the state of bone loss. Gut. 2005; 54:479–487. PMID: 15753532.
Article
5. Miheller P, Muzes G, Zagoni T, Toth M, Racz K, Tulassay Z. Infliximab therapy improves the bone metabolism in fistulizing Crohn's disease. Dig Dis. 2006; 24:201–206. PMID: 16699279.
Article
6. Tenenhouse A, Joseph L, Kreiger N, et al. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: the Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int. 2000; 11:897–904. PMID: 11199195.
Article
7. Lofman O, Larsson L, Toss G. Bone mineral density in diagnosis of osteoporosis: reference population, definition of peak bone mass, and measured site determine prevalence. J Clin Densitom. 2000; 3:177–186. PMID: 10871911.
8. Yang SK, Yun S, Kim JH, et al. Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005: a KASID study. Inflamm Bowel Dis. 2008; 14:542–549. PMID: 17941073.
Article
9. Compston JE, Judd D, Crawley EO, et al. Osteoporosis in patients with inflammatory bowel disease. Gut. 1987; 28:410–415. PMID: 3583068.
Article
10. Szathmári M, Prónai L, Tulassay Z. Altered bone metabolism in inflammatory bowel disease. Am J Gastroenterol. 1998; 93:848–849. PMID: 9625151.
Article
11. Pigot F, Roux C, Chaussade S, et al. Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci. 1992; 37:1396–1403. PMID: 1505291.
Article
12. Schulte C, Dignass AU, Mann K, Goebell H. Reduced bone mineral density and unbalanced bone metabolism in patients with inflammatory bowel disease. Inflamm Bowel Dis. 1998; 4:268–275. PMID: 9836078.
Article
13. Schoon EJ, van Nunen AB, Wouters RS, Stockbrügger RW, Russel MG. Osteopenia and osteoporosis in Crohn's disease: prevalence in a Dutch population-based cohort. Scand J Gastroenterol Suppl. 2000; (232):43–47. PMID: 11232491.
14. Robinson RJ, al-Azzawi F, Iqbal SJ, et al. Osteoporosis and determinants of bone density in patients with Crohn's disease. Dig Dis Sci. 1998; 43:2500–2506. PMID: 9824142.
15. Bernstein CN, Seeger LL, Sayre JW, Anton PA, Artinian L, Shanahan F. Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res. 1995; 10:250–256. PMID: 7754804.
Article
16. Bjarnason I, Macpherson A, Mackintosh C, Buxton-Thomas M, Forgacs I, Moniz C. Reduced bone density in patients with inflammatory bowel disease. Gut. 1997; 40:228–233. PMID: 9071937.
Article
17. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003; 124:795–841. PMID: 12612917.
Article
18. Jahnsen J, Falch JA, Aadland E, Mowinckel P. Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study. Gut. 1997; 40:313–319. PMID: 9135518.
Article
19. Walsh MC, Kim N, Kadono Y, et al. Osteoimmunology: interplay between the immune system and bone metabolism. Annu Rev Immunol. 2006; 24:33–63. PMID: 16551243.
Article
20. Henderson S, Hoffman N, Prince R. A double-blind placebo-controlled study of the effects of the bisphosphonate risedronate on bone mass in patients with inflammatory bowel disease. Am J Gastroenterol. 2006; 101:119–123. PMID: 16405543.
Article
21. Oostlander AE, Bravenboer N, Sohl E, et al. Histomorphometric analysis reveals reduced bone mass and bone formation in patients with quiescent Crohn's disease. Gastroenterology. 2011; 140:116–123. PMID: 20854819.
Article
22. Ghosh S, Cowen S, Hannan WJ, Ferguson A. Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis. Gastroenterology. 1994; 107:1031–1039. PMID: 7926456.
Article
23. Abitbol V, Roux C, Chaussade S, et al. Metabolic bone assessment in patients with inflammatory bowel disease. Gastroenterology. 1995; 108:417–422. PMID: 7835582.
Article
24. Sonnenberg A, Ehms H, Sonnenberg GE, Strohmeyer G. 25-hydroxycholecalciferol serum levels in patients with Crohn's disease. Acta Hepatogastroenterol (Stuttg). 1977; 24:293–295. PMID: 906778.
25. Driscoll RH Jr, Meredith SC, Sitrin M, Rosenberg IH. Vitamin D deficiency and bone disease in patients with Crohn's disease. Gastroenterology. 1982; 83:1252–1258. PMID: 6982188.
Article
26. Compston JE, Creamer B. Plasma levels and intestinal absorption of 25-hydroxyvitamin D in patients with small bowel resection. Gut. 1977; 18:171–175. PMID: 856674.
Article
27. Soyka LA, Fairfield WP, Klibanski A. Clinical review 117: hormonal determinants and disorders of peak bone mass in children. J Clin Endocrinol Metab. 2000; 85:3951–3963. PMID: 11095413.
28. Kirschner BS, Voinchet O, Rosenberg IH. Growth retardation in inflammatory bowel disease. Gastroenterology. 1978; 75:504–511. PMID: 680509.
Article
29. Griffiths AM, Nguyen P, Smith C, MacMillan JH, Sherman PM. Growth and clinical course of children with Crohn's disease. Gut. 1993; 34:939–943. PMID: 8344582.
Article
30. Cowan FJ, Warner JT, Dunstan FD, Evans WD, Gregory JW, Jenkins HR. Inflammatory bowel disease and predisposition to osteopenia. Arch Dis Child. 1997; 76:325–329. PMID: 9166024.
Article
31. Gokhale R, Favus MJ, Karrison T, Sutton MM, Rich B, Kirschner BS. Bone mineral density assessment in children with inflammatory bowel disease. Gastroenterology. 1998; 114:902–911. PMID: 9558278.
Article
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