Risk Factors for Worsening of Bone Loss in Patients Newly Diagnosed with Inflammatory Bowel Disease

Abstract

Background. Bone loss is common in patients with inflammatory bowel disease (IBD). The aim of the present study was to determine the prevalence of metabolic bone disease in patients newly diagnosed with IBD and to identify the risk factors for bone loss over time. Methods. We performed a retrospective, both cross-sectional and longitudinal, study to extract the risk factors of bone loss (including osteopenia and osteoporosis) in patients newly diagnosed with IBD, using dual-energy X-ray absorptiometry (DXA). Results. A total of 639 patients newly diagnosed with IBD that had at least one DXA were included in the cross-sectional study. Osteopenia and osteoporosis were diagnosed in 24.6% and 5.4% of patients, respectively. Age at diagnosis, body mass index, and serum phosphorus were identified as independent factors associated with bone loss at baseline. A total of 380 of the 639 IBD patients (including 212 CD patients and 168 UC patients) with at least a second DXA scan were included in the longitudinal study. 42.6% of the patients presented a worsening of bone loss in the follow-up study. Menopause, albumin, and use of corticosteroids were identified as independent factors associated with worsening of bone loss. Conclusions. Metabolic bone disease is common in IBD patients, and there is a significant increase in prevalence of bone loss over time. Postmenopausal female, malnourished patients, and those requiring corticosteroid treatment are at risk for persistent bone loss. Therefore, BMD measurements and early intervention with supplementation of calcium and vitamin D are recommended in IBD patients with high-risk factors.

Bone mineral density and its influential factors in Chinese patients with newly diagnosed Crohn's disease

“…Even though the impact of BMI is a less direct indicator of disease severity, it still has a significant impact on low BMD 18 . Different findings have been reported in the previous studies regarding the impact of disease duration on bone loss 17,20 . In the current study, though univariate analysis showed that a disease duration of 6 months and longer was related to low BMD, this was not shown in the multivariate analysis ( P = 0.066; T‐score).…”

“…A study on a Chinese population (n = 5593) has revealed that male patients aged 40–50 years had an osteoporosis rate of 0.4% at the femoral neck and 2.6% at the lumbar spine 15 . The prevalence of osteoporosis in our IBD patients was higher compared with that reported in the general Chinese population, 16 but is comparable to that previously reported 17 . The prevalence of low BMD in patients with IBD at the initial diagnosis may be low, which may increase during the follow‐up period according to the American Gastroenterological Association guideline.…”

“…15 The prevalence of osteoporosis in our IBD patients was higher compared with that reported in the general Chinese population, 16 but is comparable to that previously reported. 17 The prevalence of low BMD in patients with IBD at the initial diagnosis may be low, which may increase during the follow-up period according to the American Gastroenterological Association guideline. Further studies with large samples and prospective study design are needed to investigate BMD changes in patients with newly diagnosed CD.…”

Identifying microbial signatures for patients with postmenopausal osteoporosis using gut microbiota analyses and feature selection approaches

“…Lactobacillus can reduce body weight and alleviate fat accumulation in mice fed a high-fat diet ( Wang et al, 2020 ). For osteoporosis patients, increasing BMI was identified as a protective factor for bone loss ( Wang Y et al, 2022 ; Yin et al, 2022 ). The results from a large cohort survey showed that the mean rate of fragility fracture was significantly increased in the underweight group compared with the obese and normal weight groups in postmenopausal women ( Kim et al, 2021 ).…”

Risk Factors Affecting Bone Mineral Density in Inflammatory Bowel Diseases

“…24 Long-term Cs use reduces BMD and has been involved with reduced bone density in patients with IBD, although some studies did not find such a connection. 25 In a study of 166 patients with IBD, Abraham et al 26 showed that Cs use more than doubled the risk of low BMD (OR = 2.4 (1.5-3.6), P = .001). However, other studies did not reveal a clear association between low BMD and Cs use.…”