Original articleBone density in young males with recently diagnosed inflammatory bowel 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.
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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.
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Inflammatory bowel diseases, celiac disease, and bone
2010, Archives of Biochemistry and BiophysicsCitation Excerpt :Only low BMI was a significant predictor for a pathological femoral T-score. In a study by Sakellariou et al. [122], 32 GC-naïve young males with IBD at an early stage had a lower BMD than healthy controls: osteopenia or osteoporosis were found in 9 patients (28%). Duration of disease above 6 months and low BMI were major risk factors for low BMD.
Osteoporosis in inflammatory bowel disease
2008, Journal of Crohn's and ColitisCitation Excerpt :There is clear evidence that long-term use of steroids decreases bone density (for review see15). But there is also compelling evidence that there are subgroups of IBD patients which have received long-term steroid therapy without significant bone loss and steroid-naive patients who show a significant reduction of lumbar bone density upon diagnosis of their inflammatory bowel disease.16 This suggests that additional factors play a significant role in the pathophysiology of bone loss in IBD.