Disorders of Mineral and Bone Metabolism in Patients with Crohn's Disease

Abstract

Crohn's disease is known to produce malabsorption of calcium and vitamin D which affect the skeleton. A variety of techniques were used to assess the prevalence of mineral and bone abnormalities in 53 consecutive patients with Crohn's disease. Twenty healthy controls were compared with 28 men and 25 women with Crohn's disease. In males, the mean corrected serum calcium concentration was elevated, the mean winter plasma 25-hydroxyvitamin D was low, as was the bone volume on biopsy and the fractional absorption of {7Ca. In females, the corrected serum calcium was also higher than in contro ls, as was the serum alkaline phosphatase activity. The female patients had significant decreases in both summer and winter plasma vitamin D leve ls, metacarpa l cortica l thickness and fractional absorption of 47 Ca. The disturbances in bone and mineral metabolism were generally mild and were not associated with use of glucocorticosteroids but were more severe in patients with a history of bowel resection. Thus, patients with C ro hn's disease are at risk of developing metabolic bone disease and consideration should be given for an assessment of the skeleton in patients with Crohn's disease. especially in women and in patients with previous ilea! resection. A battery of tests may be needed to exclude the diagnosis of metabo lic bo ne disease but a 25-hydroxyvitamin D assay and hand x·rays using industrial grade film are recommended as a valuable preliminary assessment.Can) Gastroe nterol 1987;1(1):l l-17 (23) and th e published normal population was used as the control groups with whom the Bone metabolism In Crohn's disease TABLE4 patients, fractional calcium absorption from the gut was measured using a rad ioisotope method similar to that described by Chanard et al (33). The protocol was as follows: on day 1 of the test the subject received 1.0 µCi47CaZ+ as calcium chloride in travenously after an 8 h fast. fuur hours later, while still fasting, the radioactivity in the concralaceral fo rearm was measured usi ng a low background, two crystal gamma ray spectrometer. On day 3 of the study, fo llowing another 8 h fast, residual activity in the forearm was measured immediately before the subject received an oral dose of 4 µCi47CaH together with 180 mg elemental calcium (as 10% gl uconate). Four hours following this oral dose, while still fasting, the forear m radioactiv ity was again measured. Fractional calcium absorption was calculated as fo llows:Plasma 25-hydroxyvitamin D and percentage fractional calcium absorption T he gamma ray spectrometer system, specially constructed for these measurements, was carefully calibrated and arm positioning devices were used to assure consistent repeat m easurements of fo rearm radioactivity. The radiation background of the gamma ray spectrometer system was low and stable a nd was screened against radioactivity from pans of the subject's body other than the measu red forearm . For normal subjects. the error in the measurement (including Table 2 Vol. 1 No. 1. October 1987 cou n ti...

osteoporosis, corticosteroids and inflammatory bowel disease

“…*~~~~ Using single photon absorptiometry to measure radial bone mineral content, Hylander et aL91 reported evidence of demineralization in 11 % of a group of adults with small intestinal resection, most of whom had inflammatory bowel disease. A similar prevalence was observed, using metacarpal morphometry and photon absorptiometry to assess bone mineral content, in two studies of 82 and 53 patients with Crohn's disease respecti~ely.~~, 93 Recent studies have included measurement of bone mass in the spine and femoral neck. In a study of 75 unselected patients with inflammatory bowel disease, the prevalence of osteoporosis, defined as a bone mineral density > 2 s.d.…”

Vitamin D deficiency associated with Crohn’s disease and ulcerative colitis: a meta-analysis of 55 observational studies

“…A total of 19 cohort studies [18, 34, 38, 41, 50–56, 64, 67, 68, 71, 73, 74, 76, 77], 22 case–control studies [16, 25–29, 31–33, 35, 42, 43, 46, 49, 59–63, 66, 69, 70] and 14 cross-sectional studies [30, 36, 37, 39, 40, 44, 45, 47, 48, 57, 58, 65, 72, 75] were included in the analysis. The total number of participants was 5123 patients and 3033 healthy controls.…”

“…Table 1 shows that the quality scores of the included studies ranged from 2 to 7, with a median of 5. Thirty-two studies [16, 18, 29–31, 33–35, 37–40, 44, 45, 47–49, 51, 52, 54, 55, 61, 62, 64–66, 70, 73–77] were considered high quality and the others [25–28, 31, 36, 41–43, 46, 50, 53, 56–60, 63, 67–69, 71, 72] were low quality.…”