Bones and Crohn's: Problems and solutions

Abstract

Inflammatory bowel disease may manifest in various extra intestinal manifestations. Osteopenia and various arthropathies may be debilitating. These may be related to the disease itself, patient genetics, lifestyle, or disease treatment. Calcium and vitamin D malabsorption, vitamin K deficiency, malnutrition, corticosteroid and other immunosuppressive medications, smoking, lack of exercise and postmenopausal state may all play important roles. Treatment may be undertaken to correct nutrient deficiencies, inhibit bone resorption and increase bone formation.

Randomized Trial Comparing Two Methods of Increasing Dietary Calcium Intake in Children with Inflammatory Bowel Disease

“…Because bone accretion is maximized at a calcium intake of 1480 mg/day (27), the goal of the intervention was to increase calcium intake to 1500 mg/day. This level is slightly greater than the upper range of 1200 mg/day recommended by the National Institutes of Health Consensus Panel (28) for children aged 6 to 10 years but consistent with calcium intake recommendations for patients with Crohn disease (29) and below the threshold proposed by Matkovic and Heaney (30) as the level beyond which increased calcium intake does not improve calcium balance. It is also the level that we hypothesize would best promote long-term maintenance, as it meets the National Institutes of Health recommendations for adolescents and young adults aged 11 to 24 years.…”

Metabolic Bone Disease and Inflammatory Bowel Disease

“…Typically, a fistula forms from the terminal ileum to the ileal ischial crest. To evaluate a patient with IBD for bone pathology, the clinician should measure the serum ionized calcium and 25 OH D concentration and encourage a calcium supplement: 1,000-1,500 mg of calcium (56). (In fact, all patients should take calcium supplements because few individuals consume the recommended daily allowance for calcium.)…”

Basic and clinical aspects of osteoporosis in inflammatory bowel disease

“…Due to the low absolute risk of fracture remains controversial if all IBD patients should be screened, but it is suggested for avoiding the complications of osteoporosis, especially in patients with a preexisting bone disease, older than 65, and with risk factors for low bone mass as longterm steroid therapy (prednisone 5 mg daily for 6 mo or more) [88][89][90][91] . Both, the American College of Gastroenterology (ACG) and American Gastroenterological Association (AGA) issued position papers to offer guidance to the practicing clinician in the diagnosis and management of bone loss in IBD.…”