Bone mineral density is negatively correlated with ulcerative colitis: a systematic review and meta‐analysis

Abstract

BackgroundNewer epidemiological studies suggest that the incidence of ulcerative colitis might be increasing rapidly. Furthermore, osteoporosis in ulcerative colitis patients has gained great attention, but the epidemiologic evidence remains controversial. Therefore, a meta‐analysis was performed to explore the association between bone density and ulcerative colitis. MethodsTwo investigators used PubMed, EMBASE and the Cochrane Library databases to identify all studies published before August 2019. Depending on the outcomes, investigators divided these studies into four groups (OR, SMD [BMD], SMD [z‐score] and SMD [t‐score]). To address the use of steroids, which is a major confounding factor in this analysis, another subgroup analysis of studies of steroid‐free patients was conducted. Additionally, heterogeneity, sensitivity and stratified analyses were also performed. ResultsA total of 13 cross‐sectional studies that involved 1154 participants were included in the present meta‐analysis, and three of them were included in the steroid‐free subgroup analysis. The pooled OR was 6.41 (95% CI 2.59–15.87) and the pooled SMD (BMD), SMD (t‐score) and SMD (z‐score) were − 0.24 (95% CI − 0.44 to − 0.04), − 0.55 (95% CI − 0.72 to − 0.37), and − 0.38 (95% CI − 0.56 and − 0.19), respectively. Since steroids are a significant confounder, the pooled SMD of the steroid‐free subgroup was − 0.55 (− 0.85 to − 0.25), which revealed a strong negative relationship between bone density and ulcerative colitis in steroid‐free patients. Additionally, other subgroup analyses also revealed a strong relationship. ConclusionsThis meta‐analysis provides evidence for the potential association between ulcerative colitis and decreased bone density. It is essential for clinicians to consider bone mineral density in ulcerative colitis patients regardless of steroid‐therapy.

Exosome-based bone-targeting drug delivery alleviates impaired osteoblastic bone formation and bone loss in inflammatory bowel diseases

“… 51 , 52 Complicated with IBD, bone loss has been discussed for decades. 53 Patients with IBD are susceptible to bone structural defects and increased hip fracture incidence. 54 , 55 For the pathogenesis, increased inflammation is reported to be responsible.…”

Mendelian randomization study of inflammatory bowel disease and bone mineral density

“…In addition, CD has important immunological differences when compared to UC. The localization of CD is in the small intestine, and intestinal resection may cause malnutrition and estrogen deficiency [ 36 ]. However, in Schoon et al’s research, it concluded no significant differences in BMD between patients with either CD or UC [ 37 ].…”

Overweight and abdominal fat are associated with normal bone mineral density in patients with ulcerative colitis

“…Greater bone fragility increases the risk of fractures, and consequently morbidity and reduced quality of life for patients. The mechanisms reported in the literature associated with bone loss in UC patients are mainly related to the UC itself, the use of steroids, hospitalization[ 25 - 27 ], and low BMI values[ 28 - 31 ].…”