Metabolic bone assessment in patients with inflammatory bowel disease

Abitbol, Véred; Roux, Christian; Chaussade, Stanislas; Guillemant, S; Kolta, Sami; Dougados, Maxime; Couturier, Daniel; Amor, B

doi:10.1016/0016-5085(95)90068-3

Cited by 228 publications

(161 citation statements)

References 35 publications

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“…Also, the impact of IBD-associated factors and IBD-specifi c infl ammation on bone is not well characterized. It has been estimated that 14-42% of persons with IBD have osteoporosis, though the precise prevalence is unknown, as there are no population-based data with universal case detection (150)(151)(152). Not all persons with IBD are at equivalent risk for developing osteoporosis or developing an osteoporosis-related fracture.…”

Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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Recent data suggest that infl ammatory bowel disease (IBD) patients do not receive preventive services at the same rate as general medical patients. Patients with IBD often consider their gastroenterologist to be the primary provider of care. To improve the care delivered to IBD patients, health maintenance issues need to be co-managed by both the gastroenterologist and primary care team. Gastroenterologists need to explicitly inform the primary care provider of the unique needs of the IBD patient, especially those on immunomodulators and biologics or being considered for such therapy. In particular, documentation of up to date vaccinations are crucial as IBD patients are often treated with long-term immune-suppressive therapies and may be at increased risk for infections, many of which are preventable with vaccinations. Health maintenance issues addressed in this guideline include identifi cation, safety and appropriate timing of vaccinations, screening for osteoporosis, cervical cancer, melanoma and non-melanoma skin cancer as well as identifi cation of depression and anxiety and smoking cessation. To accomplish these health maintenance goals, coordination between the primary care provider, gastroenterology team and other specialists is necessary. of evidence, we entered data from the papers of highest evidence into the GRADE program (accessible at http://www.gradepro.org ). Th e recommendation statements from this guideline are shown in Table 1 . Summary statements, when listed, are designed to be descriptive in nature without associated evidence-based ratings. VACCINATIONSRecent data suggest that IBD patients do not receive preventive services at the same rate as general medical patients ( 2 ). Members of the gastroenterology team are oft en the only clinicians that a patient with IBD will see. As such, it is incumbent upon gastroenterologists to take a proactive role in the health care needs of their IBD patients ( 3-5 ). It is crucial to clarify with the patient the limits of the specialist's responsibilities and delegate routine health care issues to the primary care clinician. It is equally important to educate the primary care clinician to the unique health maintenance needs of the IBD patient, especially those on immunomodulators and biologic agents. Although it appears that both primary care clinicians and gastroenterologists are hesitant to take ownership of vaccinations ( 6-8 ), it is reasonable ( 9 ) that vaccination recommendations be the responsibility of the treating gastroenterologist, but the actual delivery/administration of these vaccines may be a shared responsibility ( 10-13 ). Communicating specifi c recommendations to the primary care team in a concise fashion are needed. Consider empowering the patient by giving written recommendations to bring to their primary care physician. Clinicians sharing an electronic medical record should use this platform to send recommendations to the referring clinician.Patients with IBD are oft en treated with long-term immunesuppressive therapies and may t...

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Section: Summary Of Evidencementioning

confidence: 99%

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Farraye

Melmed

Lichtenstein

et al. 2017

American Journal of Gastroenterology

403

421

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“…2 Low BMD has also been reported in 31±39% of patients with in¯ammatory bowel disease in cross-sectional and prospective studies. 1,3,5,18 The mechanism of osteopenia in in¯am-matory bowel disease is not understood, but the results suggest that there is low bone formation, in spite of normal calcium levels and the normal levels of calcium regulating hormones. Vitamin D de®ciency is not an important contributor to osteopenia.…”

Section: Discussionmentioning

confidence: 99%

“…Vitamin D de®ciency is not an important contributor to osteopenia. 1 Although a number of small studies have previously indicated that osteoporosis may also occur after jejunoileal bypass, 19 ± 21 most reviewers of the literature have emphasised the clinical effects of osteomalacia and secondary hyperparathyroidism. 21 This is certainly the case for the patients in this study who have been recruited from a meticulously studied cohort followed for over 20 y.…”

Section: Discussionmentioning

confidence: 99%

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Reduced bone mineral density after surgical treatment for obesity

et al. 1999

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OBJECTIVE: To investigate whether osteoporosis occurs after surgical treatment for obesity. DESIGN: A cross-sectional study of ®ve groups of subjects who had undergone surgical treatment for obesity: ®ve premenopausal women; 13 post-menopausal women; seven post-menopausal women taking oestrogen replacement (HRT); ®ve men; and six women who had undergone surgical reversal (mean time 7 y). SUBJECTS: Thirty-six Caucasian subjects who had undergone jejunoileal or pancreaticobiliary bypass surgery at St George's Hospital between 1971 and 1992. Their mean age was 50.8 y (range 32 ± 69 y) and the median time since the operation was 14.8 y (range 4 ± 23 y). MEASUREMENTS: A clinical questionnaire was used to exclude possible factors, which might in¯uence bone mineral density. A single blood sample was collected for measurement of calcium, phosphate, alkaline phosphatase, albumin, magnesium, zinc, creatinine, thyroxine, 25-hydroxy-vitamin D, sex steroids, gonadotrophins and IGF-1 and 24 h urine calcium excretion was measured. Bone mineral density (BMD) was measured in the lumbar (L2-L4) spine (LS) and femoral neck (FN) by dual energy X-ray absorptiometry (DEXA). RESULTS: There was no difference in serum calcium, alkaline phosphatase, IGF-1, 25-hydroxy-vitamin D (25-OH vitamin D), magnesium or zinc concentrations between the ®ve groups. The LS-BMD T score was lower (P`0.05) in male subjects ( 7 2.08 AE 1.04 mean 1.0 AE s.d) and post-menopausal women not taking HRT ( 7 1.21 AE 1.33) compared to the surgically reversed group (0.87 AE 2.36). The male group was most severely affected, despite normal serum testosterone concentrations. Two of the ®ve men studied, had a LS-BMD T score`7 2.5 and two had a LS-BMD T score between 7 1.0 and 7 2.5. In contrast, six of the seven post-menopausal women on HRT had an LS BMD T score b 7 1.0. There was no difference in the FN-BMD between the ®ve groups. The presence of low BMD was not related to age, duration of bypass, or degree of postoperative weight loss. Iliac crest bone biopsies in three subjects with low BMD, con®rmed the presence of osteoporosis. CONCLUSIONS: Reduced bone mineral density is a complication of jejunoileal bypass surgery.

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“…The reduced muscular cross-section in CIBD was typically associated with a low thickness of cortical bone and a reduced trabecular bone density [20,69]. As many as 60 % of patients with Crohn's disease are sarcopaenic, 30-40 % of patients with Crohn's disease also develop osteopaenia, and 15 % show osteoporosis, thus doubling the risk of fractures [1,6,39]. In those with osteoporosis, the prevalence of vertebral fracture was 22 %, even in patients under the age of 30 years [35].…”

Section: Reviewmentioning

confidence: 99%

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2016

Int J Sports Med

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Metabolic bone assessment in patients with inflammatory bowel disease

Cited by 228 publications

References 35 publications

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease

Reduced bone mineral density after surgical treatment for obesity

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