Osteoporosis in patients with inflammatory bowel disease

Compston, JE; Judd, D; Evans, W. Douglas; Crawley, E.O.; Evans, Carol; Rhodes, JM

doi:10.1016/8756-3282(86)90719-2

Cited by 47 publications

(76 citation statements)

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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%

“…2 In Crohn's disease, the situation may be complicated by the administration of oral glucocorticoids, but is not entirely steroidrelated. 3,4 The osteoporosis seen in female patients with Crohn's disease can be prevented by sex hormone replacement therapy (HRT). 5,6 Jejunoileal bypass surgery has been performed for morbid obesity and, more recently, for hyperlipidaemia.…”

Section: Introductionmentioning

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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduced bone mineral density after surgical treatment for obesity

et al. 1999

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“…In most previous studies no association between disease activity indices and low BMD was detected and only one publication described the Rachmilewitz Colitis activity index as a predictor for osteoporosis in a small number of UC patients. 9 Severe or persistently active disease has been established as a risk factor for osteoporosis/osteopenia; 13,27 however, up to now neither CDAI nor MTWAI but different definitions for ''severe'' and ''active'' disease have been applied including biochemical criteria such as levels of C-reactive protein (CRP) 13,27 or albumin, 28 need for ileum resection 27 and patient symptom questionnaires.…”

Section: Discussionmentioning

confidence: 99%

Prediction of low bone mineral density in patients with inflammatory bowel diseases

et al. 2016

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Background: Low bone mineral density (BMD) remains a frequent problem in patients with inflammatory bowel diseases (IBD). There is no general agreement regarding osteoporosis screening in IBD patients. Methods: Cases of low BMD and disease characteristics were retrieved from 3172 patients of the Swiss IBD cohort study. Multivariate logistic regression analysis was conducted for predictive modeling. In a subgroup of 877 patients, 253 dualenergy X-ray absorptiometry (DXA) scans were available for validation. Results: Low BMD was prevalent in 19% of patients. We identified seven predictive factors: type of IBD, age, recent steroid usage, low body mass index, perianal disease, recent high disease activity and malabsorption syndrome. Low BMD could be predicted with a sensitivity of 79% and a specificity of 64%, a positive predictive value (PPV) of 35% and a negative predictive value (NPV) of 93%. The area under the curve of the receiver operating characteristics was 0.78. In the validation cohort we calculated a PPV of 26% and an NPV of 88%. Conclusion:We provide a comprehensive analysis of risk factors for low BMD and propose a predictive model with seven clinical variables. The high NPV of models such as ours might help in excluding low BMD to prevent futile investigations.

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“…20 c-GCS, when administered for either therapy of active disease or maintenance treatment of UC or CD, may lead to severe steroid side-effects. 5,21 In other studies, patients with chronic active or frequently relapsing disease have been treated with azathioprine or 6-mercaptopurine, leading to complete remission in many cases and allowing termination of therapy with corticosteroids. 22,23 In UC, azathioprine maintenance treatment was shown to be bene®cial for at least 2 years in cases where remission had been achieved within 6 months of initiation of therapy.…”

Section: Discussionmentioning

confidence: 99%

Oral budesonide therapy for steroid‐dependent ulcerative colitis: a pilot trial

Keller¹,

Stoll²,

Foerster³

et al. 1997

Aliment Pharmacol Ther

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Background:Budesonide, a corticosteroid with high topical anti‐inflammatory activity and low systemic activity, has been shown to prolong time to relapse in Crohn's disease. In the present study, the efficacy of budesonide in an oral pH‐modified‐release formulation was evaluated for maintenance treatment in patients with steroid‐dependent ulcerative colitis.Methods:Fourteen patients with steroid‐dependent ulcerative colitis in the reduction phase of conventional glucocorticosteroids (c‐GCS) following a severe attack, were treated with budesonide 3 mg t.d.s. for 6 months. The primary investigation parameters were changes in the clinical activity index (CAI) and in the daily dose of c‐GCS.Results:In 11 cases the CAI improved significantly and treatment with c‐GCS could be terminated. Three patients experienced relapse and needed further c‐GCS treatment. The average daily dose of c‐GCS and the average value of the CAI before treatment with budesonide were significantly higher in the relapse group than in the remission group.Conclusions:In patients with c‐GCS‐dependent ulcerative colitis, a dose of 9 mg budesonide daily in an oral pH‐modified‐release formulation was well tolerated, significantly decreased the CAI, and rendered c‐GCS unnecessary in the majority of cases.

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Osteoporosis in patients with inflammatory bowel disease

Cited by 47 publications

References 0 publications

Reduced bone mineral density after surgical treatment for obesity

Reduced bone mineral density after surgical treatment for obesity

Prediction of low bone mineral density in patients with inflammatory bowel diseases

Oral budesonide therapy for steroid‐dependent ulcerative colitis: a pilot trial

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