Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study

Schüle, Solvey; Rossel, Jean‐Benoît; Frey, Diana; Biedermann, Luc; Scharl, Michael; Zeitz, Jonas; Queiroz, Natália Sousa Freitas; Kuntzen, Thomas; Greuter, Thomas; Vavricka, Stephan R.; Rogler, Gerhard; Misselwitz, Benjamin

doi:10.1097/md.0000000000006788

Cited by 33 publications

(29 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Given this risk profile in addition to age-related bone loss, Dual Energy X-ray Absorptiometry (DXA)-screening among senior IBD patients with steroid exposure and/or additional risk factors is recommended [52,86]. However, recent data indicate an inconsistent implementation of osteoporosis screening and treatment even in countries with a developed health-care system [87].…”

Section: Healthcare Maintenancementioning

confidence: 99%

Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people

et al. 2018

Self Cite

View full text Add to dashboard Cite

Approximately 10-20% of inflammatory bowel disease (IBD) cases are diagnosed after 60 years of age. Due to the high prevalence of conditions mimicking IBD at older age - including bowel disease associated with non-steroidal anti-inflammatory drugs, diverticulitis, and microscopic colitis - differential diagnosis of IBD among older adults is frequently delayed. Late-onset IBD is characterized by a predominance of colonic disease and an overall milder disease course; disease progression and new intestinal manifestations are rare. However, older patients are less able to tolerate inflammation and their risk of mortality from severe disease is increased. Management of late-onset IBD has been insufficiently studied since older adults are underrepresented in clinical trials and specific problems of older patients such as incontinence have not been addressed. To date, treatment generally follows the same principles as in the younger. However, older patients are at higher risk of severe adverse effects of the disease and its treatments, including bone and muscle loss, infections and lymphoma. Therefore, the safety profile of a given drug is of paramount importance in older patients with IBD. Colectomy with ileo-anal pouch anastomosis for refractory ulcerative colitis can be performed safely, although functional results may be inferior to those in middle-aged patients. To decrease mortality among older patients, a timely surgical intervention is important. Patients with late-onset IBD frequently develop colorectal carcinoma within 8 years of diagnosis; therefore, colorectal cancer screening immediately after diagnosis should be considered. Further, the clinical care of older patients with IBD needs to extend to overall health, including nutrition, vaccination, bone, muscle and mental health.

show abstract

Section: Healthcare Maintenancementioning

confidence: 99%

Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Regarding the screening and treatment of osteoporosis in adult patients with IBD, a Swiss IBD cohort study of 877 patients reported that 253 of the 877 participants underwent dual-energy X-ray absorptiometry (DXA), which revealed osteoporosis in about 20% of the tested patients. 10) In practice, treatment rates for IBD patients with osteoporosis were suboptimal; success rates of only 55% for calcium and 65% for vitamin D were noted, 10) remaining low at 53% for calcium and 58% for vitamin D even in patients also on systemic steroid therapy. 10) Only 29% of IBD patients with osteoporosis in that study were treated with bisphosphonate.…”

Section: Screening and Treatment Practice For Bone Health In Ibdmentioning

confidence: 99%

“…10) In practice, treatment rates for IBD patients with osteoporosis were suboptimal; success rates of only 55% for calcium and 65% for vitamin D were noted, 10) remaining low at 53% for calcium and 58% for vitamin D even in patients also on systemic steroid therapy. 10) Only 29% of IBD patients with osteoporosis in that study were treated with bisphosphonate. Overall, the screening and treatment of osteoporosis were not timely in IBD patients, although appropriate calcium and vitamin D supplementation was significantly associated with improvement of BMD over time.…”

Section: Screening and Treatment Practice For Bone Health In Ibdmentioning

confidence: 99%

“…Overall, the screening and treatment of osteoporosis were not timely in IBD patients, although appropriate calcium and vitamin D supplementation was significantly associated with improvement of BMD over time. 10) In children with IBD, DXA can also be applied to screen bone health status. According to a recent study on musculoskeletal Fig.…”

Section: Screening and Treatment Practice For Bone Health In Ibdmentioning

confidence: 99%

“…All pediatric patients with IBD, especially CD, using steroids; having a persistently active disease status; or showing risk factors such as poor nutrition, low calcium intake, limited physical activity, previous fracture history or family history of osteoporotic fracture, late menarche after 15 years of age; or smoking or excessive alcohol intake should be routinely screened for bone health status by means of DXA in addition to full correction of any potential calcium and vitamin D deficiencies to facilitate timely therapeutic intervention of patients at risk. 8,10) According to recommendations from the position paper by the Porto IBD group of the European Society of Pediatric Gastroenterology Hepatology and Nutrition (ESPGHAN), calcium intake should be monitored in children and adolescents with IBD, and low calcium intake should be supplemented. 13) ESPGHAN also recommended pursuing monitoring of vitamin D level in all children with IBD and vitamin D supplementation in children with IBD when vitamin D deficiency is present, i.e., 25(OH) vitamin D concentration below 50 nmol/L or 20 ng/ mL.…”

Section: Screening and Treatment Practice For Bone Health In Ibdmentioning

confidence: 99%

See 2 more Smart Citations

Updates on bone health in children with gastrointestinal diseases

Yang

2020

Ann Pediatr Endocrinol Metab

View full text Add to dashboard Cite

Chronic gastrointestinal diseases such as inflammatory bowel disease, malabsorption syndromes (e.g., intestinal lymphangiectasia, celiac disease, congenital chloride diarrhea, cystic fibrosis), and postsubtotal gastrectomy state or short-bowel syndrome after extensive bowel resection are related to poor bone health in pediatric patients due to increased risks of low bone mineral density, osteoporosis, and fractures. The pathophysiology of abnormal bone health in pediatric gastrointestinal diseases may present from inflammation to malabsorption. In children with chronic gastrointestinal diseases at high risk of poor bone health, routine evaluation using dual-energy X-ray absorptiometry and appropriate prevention or treatment strategies are needed.

show abstract

Bone health screening practices with dual‐energy X‐ray absorptiometry and prediction of abnormal results in pediatric inflammatory bowel disease

Morrow,

de Zoeten,

et al. 2023

J. pediatr. gastroenterol. nutr.

View full text Add to dashboard Cite

ObjectivesPediatric patients diagnosed with inflammatory bowel disease (IBD) are at risk of suboptimal peak bone mass attainment. This study aimed to understand rates of bone health screening adherence, describe factors associated with dual‐energy X‐ray absorptiometry (DXA) acquisition, and identify factors associated with abnormal DXA.MethodsWe performed a retrospective cohort study of pediatric IBD patients over a 10‐year time frame. We included IBD patients (2–20 years of age) enrolled in ImproveCareNow and excluded patients with primary metabolic bone disease. Time‐to‐event methods and multivariable logistic regression were employed to identify factors associated with DXA acquisition and abnormal DXA.ResultsIn 676 patients, 464 (68.63%) pediatric patients with IBD had a risk factor for low bone mineral density (BMD); 137 (29.53%) underwent an initial DXA scan. Quiescent disease was significantly associated with a reduced likelihood of DXA (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24–0.97), while weight z‐score <−2 was significantly associated with DXA performance (HR: 2.07; 95% CI: 1.08–3.98). Abnormal DXA results (BMD z‐score ≤−1) occurred in 59 (35.54%) individuals. After adjusting for visit diagnosis, delayed puberty, severe disease course, 6 months or greater of steroid exposure, and history of fracture, BMI z‐score <−1 (odds ratio: 5.45; 95% CI: 2.41–12.33) was associated with abnormal DXA.ConclusionsDXA screening occurred in less than one‐third of eligible pediatric IBD patients. Compliance was more common in patients with a weight z‐score <−2 and less common in those with quiescent disease. BMI strongly predicted abnormal DXA results when adjusting for risk factors for abnormal BMD.

show abstract

Widely differing screening and treatment practice for osteoporosis in patients with inflammatory bowel diseases in the Swiss IBD cohort study

Abstract: Supplemental Digital Content is available in the text

Cited by 33 publications

References 52 publications

Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people

Clinical manifestations, pathophysiology, treatment and outcome of inflammatory bowel diseases in older people

Updates on bone health in children with gastrointestinal diseases

Bone health screening practices with dual‐energy X‐ray absorptiometry and prediction of abnormal results in pediatric inflammatory bowel disease

Contact Info

Product

Resources

About