Efficacy and safety of medical therapy for low bone mineral density in patients with Crohn disease

Zhao, Xiaojing; Zhou, Changcheng; Chen, Han; Ma, Jingjing; Zhu, Yunjuan; Wang, Peixue; Zhang, Yi; Ma, Haiqin; Zhang, Hongjie

doi:10.1097/md.0000000000006378

Cited by 15 publications

(8 citation statements)

References 53 publications

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“…Most likely, antiresorptive treatment with zoledronic acid did not inhibit the decrease in BMD. Antiresorptive treatment has been demonstrated to increase BMD in patients with Crohn's disease but is usually contraindicated in hypophosphatemic osteomalacia …”

Section: Discussionmentioning

confidence: 99%

Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report

Bartko

Roschger

Zandieh

et al. 2017

Journal of Bone and Mineral Research

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Intravenous infusions of different iron formulations are recognized as a cause of hypophosphatemia. Chronic hypophosphatemia can alter bone metabolism and bone material structure. As a consequence, osteomalacia may develop and lead to bone fragility. Herein, we report a patient with Crohn's disease presenting with persistent hypophosphatemia and insufficiency fractures while receiving regular iron infusions due to chronic gastrointestinal bleeding. Previously, the patient regularly received vitamin D and also zoledronic acid. The patient underwent bone biopsy of the iliac crest that showed typical signs of osteomalacia with dramatically increased osteoid volume and decreased bone formation. Analysis of the bone mineralization density distribution (BMDD) revealed a more complex picture: On the one hand, there was a shift to higher matrix mineralization, presumably owing to low bone turnover; on the other hand, a broadening of the BMDD indicating more heterogeneous mineralization due to osteomalacia was also evident. This is the first report on changes of bone histomorphometry and bone matrix mineralization in iron-induced osteomalacia. © 2017 American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 99%

Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report

Bartko

Roschger

Zandieh

et al. 2017

Journal of Bone and Mineral Research

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“…Among the pharmaceutical options for treatment of osteopenia and osteoporosis, both bisphosphonates (e.g. alendronate, risedronate, ibandronate, and zoledronate) and sodium fluoride have been found to be effective in patients with UC or CD [ 156 , 157 ]. In a network meta-analysis, zoledronate had the highest probability to be the best treatment to increase lumbar spine bone mineral density in patients with CD, and risedronate showed the greatest power to decrease the risk of adverse effects of drugs [ 156 ].…”

Section: The Asian Working Group Guidelines Regarding Diet In Inflammmentioning

confidence: 99%

“…alendronate, risedronate, ibandronate, and zoledronate) and sodium fluoride have been found to be effective in patients with UC or CD [ 156 , 157 ]. In a network meta-analysis, zoledronate had the highest probability to be the best treatment to increase lumbar spine bone mineral density in patients with CD, and risedronate showed the greatest power to decrease the risk of adverse effects of drugs [ 156 ]. Patients should be screened for micronutrient deficiency including calcium, phosphate, magnesium, iron, folic acid, and vitamin B 12 in an appropriate clinical context.…”

Section: The Asian Working Group Guidelines Regarding Diet In Inflammmentioning

confidence: 99%

Diet and inflammatory bowel disease: The Asian Working Group guidelines

Sood

Ahuja

Kedia

et al. 2019

Indian J Gastroenterol

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Introduction These Asian Working Group guidelines on diet in inflammatory bowel disease (IBD) present a multidisciplinary focus on clinical nutrition in IBD in Asian countries. Methodology The guidelines are based on evidence from existing published literature; however, if objective data were lacking or inconclusive, expert opinion was considered. The conclusions and 38 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results Diet has an important role in IBD pathogenesis, and an increase in the incidence of IBD in Asian countries has paralleled changes in the dietary patterns. The present consensus endeavors to address the following topics in relation to IBD: (i) role of diet in the pathogenesis; (ii) diet as a therapy; (iii) malnutrition and nutritional assessment of the patients; (iv) dietary recommendations; (v) nutritional rehabilitation; and (vi) nutrition in special situations like surgery, pregnancy, and lactation. Conclusions Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 38 recommendations.

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“…Los bifosfonatos son tal vez los medicamentos más ampliamente estudiados para el tratamiento de osteoporosis. Por lo que se ha demostrado que el ácido zoledrónico es la mejor estrategia terapéutica para la mejoría de la densidad mineral ósea, mientras que el risedronato tuvo la menor cantidad de efectos adversos en un metanalisis realizado con pacientes con enfermedad de Crohn (26) . Sin embargo, hacen falta más estudios con los diferentes grupos de medicamentos en esta población específica.…”

Section: Implicaciones Terapéuticasunclassified

Metabolismo óseo, osteoporosis y enfermedad inflamatoria intestinal en adultos

Duque

Moreno

Arteaga

et al. 2019

Rev.ACE

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La osteoporosis secundaria es la disminución de la densidad mineral ósea y la alteración en la microarquitectura del tejido óseo, que conlleva un aumento en el riesgo de fracturas, y que es debida a factores diferentes a la edad y la postmenopausia. Los pacientes con enfermedad inflamatoria intestinal tienen una compleja interacción de factores que propicia la aparición de osteoporosis. La identificación correcta de los mecanismos desencadenantes ha sido un reto, teniendo en cuenta la diversidad de medicamentos, condiciones y enfermedades que convergen en el paciente con una enfermedad inflamatoria intestinal. Entender los factores de riesgo y la importancia de mecanismos fisiopatológicos puede permitir un mejor enfoque preventivo y terapéutico. Se presenta el caso de una mujer de 59 años con colitis ulcerativa desde los 18 años, manejada con múltiples cursos de esteroides, con signos clínicos y paraclínicos de malnutrición. La paciente asiste por dolor lumbar, lo que lleva al diagnóstico de fracturas vertebrales. Se describen múltiples mecanismos causales de osteoporosis en la paciente, incluida falla ovárica prematura, deficiencia de vitamina D, desnutrición y uso de esteroides. Esta revisión se centra en la fisiopatología de la osteoporosis secundaria a enfermedad inflamatoria intestinal y su abordaje diagnóstico y terapéutico en el contexto de un caso ilustrativo.

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Efficacy and safety of medical therapy for low bone mineral density in patients with Crohn disease

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 53 publications

Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report

Hypophosphatemia, Severe Bone Pain, Gait Disturbance, and Fatigue Fractures After Iron Substitution in Inflammatory Bowel Disease: A Case Report

Diet and inflammatory bowel disease: The Asian Working Group guidelines

Metabolismo óseo, osteoporosis y enfermedad inflamatoria intestinal en adultos

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