Reduced bone density in patients with inflammatory bowel disease.

Bjarnason, Ingvar; Macpherson, Andrew J.; Mackintosh, C.; Buxton-Thomas, M.; Forgács, I; Moniz, Caje

doi:10.1136/gut.40.2.228

Cited by 325 publications

(257 citation statements)

References 23 publications

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“…1,2 Low BMD in IBD can be seen both in males and females, and may occur in relatively young patients. 3 Osteoporosis is an important cause of morbidity because of the increased risk of fragility fractures; the fracture risk reported in Crohn's disease (CD) is 6%.…”

Section: Introductionmentioning

confidence: 99%

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

et al. 2010

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This study aimed to compare the bone mineral density (BMD) of patients with ulcerative colitis (UC) and Crohn's disease (CD) in order to determine the possible risk factors for bone loss. A total of 142 patients with UC (n = 88) and CD (n = 54) participated in the study. They were assessed for gender, body mass index (BMI), disease duration and activity, intestinal site of involvement, history of bowel resection, use of steroids, and extraintestinal findings and complications. The BMD was measured by dual-energy X-ray absorptiometry. There were no differences in BMD between UC and CD patients. In UC patients, BMI showed a significant positive correlation with BMD. Femoral neck Z scores were lower in patients with extra-intestinal findings and complications. Steroid use, disease activity, disease localization, disease duration, bowel surgery and gender had no influence on BMD. Complications or extra-intestinal involvement were a significant predictor for BMD in both groups.

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Section: Introductionmentioning

confidence: 99%

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

et al. 2010

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“…Estimates of osteopenia in IBD range from 31 to 59% and osteoporosis from 5 to 41%. Various studies exploring the cause of low BMD in IBD found a significant correlation between glucocorticoid treatment and decreased BMD (3,5,17,28,29). Glucocorticoids, such as prednisolone, are wellknown drugs for their potent anti-inflammatory and immunosuppressive properties.…”

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confidence: 99%

Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6

Huybers¹,

Naber²,

Bindels³

et al. 2007

American Journal of Physiology-Gastrointestinal and Liver Physi

103

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Huybers S, Naber TH, Bindels RJ, Hoenderop JG. Prednisolone-induced Ca 2ϩ malabsorption is caused by diminished expression of the epithelial Ca 2ϩ channel TRPV6. Am J Physiol Gastrointest Liver Physiol 292: G92-G97, 2007. First published August 10, 2006; doi:10.1152/ajpgi.00317.2006.-Glucocorticoids, such as prednisolone, are often used in clinic because of their anti-inflammatory and immunosuppressive properties. However, glucocorticoids reduce bone mineral density (BMD) as a side effect. Malabsorption of Ca 2ϩ in the intestine is supposed to play an important role in the etiology of low BMD. To elucidate the mechanism of glucocorticoid-induced Ca 2ϩ malabsorption, the present study investigated the effect of prednisolone on the expression and activity of proteins responsible for active intestinal Ca 2ϩ absorption including the epithelial Ca 2ϩ channel TRPV6, calbindin-D9K, and the plasma membrane ATPase PMCA1b. Therefore, C57BL/6 mice received 10 mg/kg body wt prednisolone daily by oral gavage for 7 days and were compared with control mice receiving vehicle only. An in vivo 45 Ca 2ϩ absorption assay indicated that intestinal Ca 2ϩ absorption was diminished after prednisolone treatment. We showed decreased duodenal TRPV6 and calbindin-D9K mRNA and protein abundance in prednisolone-treated compared with control mice, whereas PMCA1b mRNA levels were not altered. Importantly, detailed expression studies demonstrated that in mice these Ca 2ϩ transport proteins are predominantly localized in the first 2 cm of the duodenum. Furthermore, serum Ca 2ϩ and 1,25-dihydroxyvitamin D 3 [1,25(OH)2D3] concentrations remained unchanged by prednisolone treatment. In conclusion, these data suggest that prednisolone reduces the intestinal Ca 2ϩ absorption capacity through diminished duodenal expression of the active Ca 2ϩ transporters TRPV6 and calbindin-D 9K independent of systemic 1,25(OH)2D3.1,25-dihydroxyvitamin D3; duodenum; epithelial calcium channel 2; calcium transporter 1 REDUCED BONE MINERAL DENSITY (BMD) is particularly present in the elderly and women, which implies that age and gender are important risk factors for developing low BMD. However, in clinical practice low BMD is frequently observed in several patient groups, including inflammatory bowel disease (IBD) patients. Estimates of osteopenia in IBD range from 31 to 59% and osteoporosis from 5 to 41%. Various studies exploring the cause of low BMD in IBD found a significant correlation between glucocorticoid treatment and decreased BMD (3,5,17,28,29). Glucocorticoids, such as prednisolone, are wellknown drugs for their potent anti-inflammatory and immunosuppressive properties. As a consequence, glucocorticoids are widely used in clinic as drugs to treat inflammatory conditions such as IBD. To date, glucocorticoids are generally accepted to reduce BMD, despite the fact that in a number of studies an effect on bone mass could not be observed (5, 11) or could be observed only in male glucocorticoid users (31).This effect of glucocorticoids on BMD is caused by the c...

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“…Studies of bone marker levels in patients with IBD have produced conflicting results. While some studies of have reported increased levels of bone resorptive markers without a compensatory increase in formation markers (31)(32)(33)(34)(35) , other studies have reported reduced levels of markers of bone formation and no difference in resorptive markers (36) , elevated levels of both types of markers (37)(38)(39)(40) or indeed no difference in markers (41) between patients with IBD and control subjects. However, in addition to differences in the biochemical markers used, some caution is also warranted in comparing the results of some of these studies because of major differences in the various populations of patients with IBD that were studied, especially in relation to the type of disease (CD v. UC), corticosteroid usage and disease activity (active disease v. disease remission) (42) .…”

Section: Risk Factors For Osteoporosismentioning

confidence: 99%

Altered bone metabolism in inflammatory disease: role for nutrition

Cashman

2008

Proc. Nutr. Soc.

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Osteoporosis is a major public health problem, and as life expectancy and the world's population continue to increase will become even more important. Thus, there is an urgent need to develop and implement nutritional approaches and policies for the prevention and treatment of osteoporosis. Patients with some chronic inflammatory diseases appear to be more likely to develop osteopenia, and in some cases earlier in life, which is of particular concern as the incidence of inflammatory diseases in the Western world is increasing. While the cause of bone loss in patients with inflammatory disease is multifactorial, nutrition may have a role. Many of these patients may have one or more nutritional deficiencies, which can lead to altered rates of bone metabolism. On the other hand, some nutritional factors may attenuate the inflammatory process itself, and thus may indirectly benefit bone metabolism and bone health in patients with inflammatory disease. The present review will consider these issues, particularly in the context of inflammatory bowel disease, coeliac diease and atherosclerosis.

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Reduced bone density in patients with inflammatory bowel disease.

Cited by 325 publications

References 23 publications

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6

Altered bone metabolism in inflammatory disease: role for nutrition

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Reduced bone density in patients with inflammatory bowel disease.

Cited by 325 publications

References 23 publications

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

Relationship between Bone Mineral Density and Clinical Features in Patients with Inflammatory Bowel Disease: A Local Study in Turkish Population

Prednisolone-induced Ca2+malabsorption is caused by diminished expression of the epithelial Ca2+channel TRPV6

Altered bone metabolism in inflammatory disease: role for nutrition

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Prednisolone-induced Ca²⁺malabsorption is caused by diminished expression of the epithelial Ca²⁺channel TRPV6