Bone Mineral Density, Vitamin D, and Disease Activity in Children Newly Diagnosed with Inflammatory Bowel Disease

Ghishan FK, Kiela PR. Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases. Am J Physiol Gastrointest Liver Physiol 300: G191-G201, 2011. First published November 18, 2010 doi:10.1152/ajpgi.00496.2010.-Chronic inflammatory disorders such as inflammatory bowel diseases (IBDs) affect bone metabolism and are frequently associated with the presence of osteopenia, osteoporosis, and increased risk of fractures. Although several mechanisms may contribute to skeletal abnormalities in IBD patients, inflammation and inflammatory mediators such as TNF, IL-1␤, and IL-6 may be the most critical. It is not clear whether the changes in bone metabolism leading to decreased mineral density are the result of decreased bone formation, increased bone resorption, or both, with varying results reported in experimental models of IBD and in pediatric and adult IBD patients. New data, including our own, challenge the conventional views, and contributes to the unraveling of an increasingly complex network of interactions leading to the inflammationassociated bone loss. Since nutritional interventions (dietary calcium and vitamin D supplementation) are of limited efficacy in IBD patients, understanding the pathophysiology of osteopenia and osteoporosis in Crohn's disease and ulcerative colitis is critical for the correct choice of available treatments or the development of new targeted therapies. In this review, we discuss current concepts explaining the effects of inflammation, inflammatory mediators and their signaling effectors on calcium and phosphate homeostasis, osteoblast and osteoclast function, and the potential limitations of vitamin D used as an immunomodulator and anabolic hormone in IBD.bone mineral density; Crohn's disease; osteopenia; osteoporosis; ulcerative colitis INFLAMMATORY BOWEL DISEASES (IBDs) represent a group of chronic inflammatory disorders of the intestinal tract that to this date remains idiopathic. More recent basic and clinical research indicates that the chronic inflammatory reaction of the intestinal mucosa is directed against the gut microbiota in individuals with genetic and/or environmental susceptibilities. Disease onset occurs typically during young adulthood (25-35 yr), although ϳ20 -25% of cases are diagnosed during childhood (93). On a clinical basis, two major subtypes of IBD are defined as Crohn's disease (CD), which potentially affects any part of the gastrointestinal tract from the mouth to the anus, and ulcerative colitis (UC), an inflammatory condition limited to the colonic mucosa. However, IBD does not affect just a single organ and should be considered a systemic disease with several extraintestinal manifestations, which occur in a large proportion of IBD patients (60). Osteopenia and osteoporosis are two of the more common extraintestinal symptoms with a general consensus that IBD patients are at a significantly higher risk of developing metabolic bone disease and low bone mineral density (BMD) than the healthy subjects. The relative risk of fractur...

show abstract

“…This was documented for both children with IBD (e.g., Ref. 34) as well as in many studies with adult IBD patients (e.g., Ref. 61).…”

Section: Vitamin D Status In Ibdmentioning

confidence: 55%

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Ghishan

Kiela

2011

American Journal of Physiology-Gastrointestinal and Liver Physi

View full text Add to dashboard Cite

show abstract

“…No correlation between vitamin D levels and disease activity was observed in two cross-sectional studies (4,21) while a retrospective study concluded that vitamin D deficiency was associated with increased disease activity in patients with CD, but not with UC (33) . A recent study prospectively analyzed the association between vitamin D deficiency and the need for IBD-related surgery or hospitalizations in a large cohort of 3,217 patients and concluded that vitamin D deficiency was associated with an increased risk of surgery and hospitalization compared with those patients with adequate vitamin D levels (2) .…”

Section: Discussionmentioning

confidence: 99%

Lower Levels of Vitamin D Correlate With Clinical Disease Activity and Quality of Life in Inflammatory Bowel Disease

Castro

Magalhães

Carvalho

et al. 2015

Arq. Gastroenterol.

View full text Add to dashboard Cite

show abstract

“…Observational studies which have focused on vitamin D and its effect on clinical markers such as CDAI (a research tool used to quantify the symptoms of patients with Crohn's disease) and inflammatory markers have been inconclusive. In crosssectional IBD cohort studies El-Matary et al (81) and Hassan et al (42) reported no association between 25(OH)D and CDAI. CDAI levels <150 are indicative of remission, whereas levels above that suggest active disease.…”

Section: Vitamin D and Immune Function In Crohn's Disease: Experimentmentioning

confidence: 95%

Optimal vitamin D levels in Crohn's disease: a review

Raftery

O’Sullivan

2014

Proc. Nutr. Soc.

View full text Add to dashboard Cite

Vitamin D deficiency is common among patients with Crohn's disease. Serum 25-hydroxyvitamin D (25(OH)D) is the best measure of an individual's vitamin D status and current cut-off ranges for sufficiency are debatable. Several factors contribute to vitamin D deficiency in Crohn's disease. These include inadequate exposure to sunlight, inadequate dietary intake, impaired conversion of vitamin D to its active metabolite, increased catabolism, increased excretion and genetic variants in vitamin D hydroxylation and transport. The effects of low 25(OH)D on outcomes other than bone health are understudied in Crohn's disease. The aim of the present review is to discuss the potential roles of vitamin D and the possible levels required to achieve them. Emerging evidence suggests that vitamin D may have roles in innate and adaptive immunity, in the immune-pathogenesis of Crohn's disease, prevention of Crohn's disease-related hospitalisations and surgery, in reducing disease severity and in colon cancer prevention. The present literature appears to suggest that 25(OH)D concentrations of ≥75 nmol/l may be required for non-skeletal effects; however, further research on optimal levels is required.

show abstract

Bone Mineral Density, Vitamin D, and Disease Activity in Children Newly Diagnosed with Inflammatory Bowel Disease

Cited by 90 publications

References 17 publications

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Advances in the understanding of mineral and bone metabolism in inflammatory bowel diseases

Lower Levels of Vitamin D Correlate With Clinical Disease Activity and Quality of Life in Inflammatory Bowel Disease

Optimal vitamin D levels in Crohn's disease: a review

Contact Info

Product

Resources

About