Elsevier

Joint Bone Spine

Volume 73, Issue 6, December 2006, Pages 725-728
Joint Bone Spine

Original article
Bone density in young males with recently diagnosed inflammatory bowel disease

https://doi.org/10.1016/j.jbspin.2006.01.017Get rights and content

Abstract

Objectives

Patients with inflammatory bowel disease are at increased risk of developing osteopenia and osteoporosis. Our study was designed to determine the degree of decreased bone density in steroid naïve young male patients with inflammatory bowel disease and to unmask possible risk factors.

Methods

Before the initiation of any treatment in young male patients aged 26 ± 4.8 years with inflammatory bowel disease, ultrasound bone density measurement at the right calcaneous was performed using a Lunar Achilles plus device. Stiffness Index and T-score were measured. We also performed an ultrasound bone density measurement at right calcaneous in healthy age- and sex-matched controls.

Results

Nine out of 32 patients with inflammatory bowel disease had osteopenia or osteoporosis (~28%). Of controls, two individuals had osteopenia (~7%). There was a positive correlation between T-score and body mass index, but not between T-score and age in patients with inflammatory bowel disease. There was a statistically significant difference in T-score between patients with disease duration > 6 months and those with disease duration < 6 months (P = 0.032), but not between the patients with Crohn's disease compared with the patients with ulcerative colitis.

Conclusion

Steroid naïve young male patients with inflammatory bowel disease have lower bone density values than healthy controls. According to our findings, duration of disease above 6 months and low body mass index are major risk factors for low bone density in these patients. Bone density measurement should be performed in all patients with inflammatory bowel disease in an early stage of the disease.

Introduction

Patients with inflammatory bowel disease (IBD) have lower bone mineral density (BMD) values than healthy controls [1], [2], [3], [4]. At diagnosis, low BMD appears to be more common in those with Crohn's disease (CD) than in those with ulcerative colitis (UC) [5]. The pathogenesis of osteopenia and/or osteoporosis associated with IBD is multifactorial [6]. Steroid therapy plays an important role in some patients with IBD and osteopenia [7], while the pathogenesis of disease might be involved in the BMD reduction in patients with CD [8]. The nutrients important to bone formation (especially calcium and vitamin D) are absorbed in the small intestine, so people with CD who have had extensive disease of the small intestine may be at additional risk for low bone density [9], [10]. It is also possible that a high inflammatory activity directly induces bone degradation via yet unknown pathways in IBD-associated bone disease [6]. It is important to determine whether IBD has a direct bearing on those patients who ultimately become osteopenic. This study was designed to determine the degree of decreased bone density in steroid naïve young male patients with IBD at the time of initial diagnosis and the possible risk factors.

Section snippets

Methods

Young male patients aged over 20 years with recently diagnosed IBD were enrolled in the study. The diagnosis of IBD was based on endoscopy with histological findings. Before the initiation of any treatment, ultrasound bone density measurement at the right calcaneous was performed using a Lunar Achilles plus device. Further, we performed an ultrasound bone density measurement at right calcaneous in age-matched young normal males. Individuals having a history of previous corticosteroid use for

Results

Thirty-two young male patients with recently diagnosed IBD [mean (± S.D.) age 26 ± 4.8 (range 20–36) years and mean BMI (± S.D.) 24.1 ± 4.3 (range 15.4–31) kg/m2] and 28 young healthy males [mean (± S.D.) age 24.6 ± 6.2 (range 20–40) years and mean BMI (± S.D.) 23.2 ± 4.5 (range 17.5–34.8) kg/m2] participated in the study. Patients and controls' data is shown in Table 1. Of 32 patients, eighteen had CD and 14 had UC. In regard to estimated duration of symptoms, 18 patients, 10 with CD and the remainder

Discussion

Because the pathogenesis of osteoporosis in IBD is still not clear, a careful analysis of the metabolic state of the bone at the initial phase of IBD may provide some important clues. In this prospective compared-control study, we found that nine (~28%) of 32 steroid naïve young male patients with recently diagnosed IBD had osteopenia or osteoporosis compared with two (~7%) of controls who had osteopenia. Bone density was associated with BMI only in patients with IBD but not in controls.

References (25)

  • AD. Harries et al.

    Vitamin D status in Crohn's disease: association with nutrition and disease activity

    Gut

    (1985)
  • H. Vogelsang et al.

    Bone disease in vitamin D deficient patients with Crohn’s disease

    Dig. Dis. Sci.

    (1989)
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