Patients with inflammatory bowel disease often experience low bone density as well. Drs Misra and Pani offer insight into monitoring and managing bone health in IBD.
Assistant Professor, Department of Internal Medicine, UVA School of Medicine; Medical Director, Department of General Medicine, Same Day Care Clinic, Charlottesville, VirginiaProfessor, Chair, Physician-in-Chief, Department of Pediatrics, University of Virginia and UVA Health Children's, Charlottesville, VirginiaThe connection between IBD and low bone density is multifactorial.
Researchers report that contributing factors include chronic active disease and medications, general lifestyle factors — such as low physical activity and poor nutrition — and hormonal changes. Clinicians can monitor bone density, advise on optimizing lifestyle factors, recommend supplements as necessary, and consider pharmacologic therapy for osteoporosis.in patients with IBD compared to the general population. This study also reported that the increased risk is significant only for the spine . However, another population-based study found a, additional risk factors include impaired longitudinal growth, reduced lean mass, and delayed puberty. There is emerging evidence that use of biologics in IBD are common in patients with IBD. A majority of patients with Crohn’s have low serum calcidiol , which is worse if there is an associated small bowel resection. is common in patients with IBD due to impaired nutritional status, chronic inflammation, and long-term glucocorticoid use; it is an important contributor to low bone density. Delayed puberty is a risk factor for low bone density in. Deficiency of the gonadal steroids results in increased bone resorption and decreased bone formation. Chronic glucocorticoid treatment impairs calcium absorption from the gut, the renal handling of calcium, bone formation, bone resorption, the growth hormone-RANKL is expressed by cells of the osteoblast lineage and binds to a receptor on osteoclast precursors called RANK resulting in activation of cells of the osteoclast lineage to begin the process of bone resorption. However, RANKL can also bind to a soluble decoy receptor called OPG, which blocks the interaction of RANKL and RANK, thus preventing osteoclast differentiation, activation, and bone resorption. , the increase in RANKL is only transient, and the failure of bone formation seems to be more important contributor to impaired bone health than bone resorption., a commonly used oral glucocorticoid with mostly local and limited systemic effects, allows for sparing of bone density in patients with IBD, although studies are conflicting. Of note, studies have reportedExcessive alcohol use and smoking are risk factors for low bone mineral density and increased fracture risk in patients with IBD, as they are in general.at the lumbar spine and hip in adults and at the spine and whole body less head in children . In post-menopausal women and men older than 50, osteoporosis is defined as bone mineral density that is at least 2.5 SDs below peak bone mass in healthy adults. Osteopenia, a precursor of osteoporosis, is defined as bone mineral density between 1 and 2.5 SDs below peak bone mass. In individuals younger than 50, low bone density is defined as “below the expected range of age” . In children, the diagnosis of osteoporosis requires both a low bone mineral density and a significant fracture history. The latter includes a vertebral compression fracture or at least two long bone low impact fractures by the age 10 or at least three long bone low impact fractures by the age 19. A vertebral compression fracture qualifies for a diagnosis of osteoporosis regardless of bone density. Patients with a previous fragility fracture should be evaluated with a DXA scan and monitored over time. Other high-risk individuals are patients who have received prolonged or repeated courses of glucocorticoids, those older than 50, and those younger than 50 with other risk factors such as chronic active disease, malabsorption, weight loss, nutritional deficiencies, decreased physical activity, hypogonadism, chronic glucocorticoid therapy, poorly controlled IBD with persistent underlying inflammation, history of gut resection, excess alcohol intake, and a history of smoking. recommends repeat bone mineral density testing every 2-3 years. However, yearly DXA measurements are recommended for children and those showing >3% decrease in bone mineral density annually. Further, DXA scans may be if the patient develops clinical features of cortisol excess from glucocorticoid therapy, including increasing BMI z-scores. Management of Bone Health It is important to optimize weight and nutrition. Every attempt should be made to ensure optimal intake of calcium and vitamin D in diet or as supplements. Recommendations include at leastis better absorbed and less likely to be associated with renal stones. However, higher doses of calcium and vitamin D may be necessary in some individuals, particularly when there is ongoing malabsorption. help maintain or improve bone density. Avoiding excess alcohol intake and quitting smoking are important. Hypogonadal individuals should receive gonadalscore may be used to get an estimate of the 10-year probability of major fracture risk. Oral bisphosphonates are the first-line pharmacologic option.or risedronate are given orally weekly. IV zoledronic acid is a good option for those who cannot tolerate or absorb oral bisphosphonates and is given every 6-12 months . Those with several fractures despite having tried other drugs can try a bone anabolic agent, such as teriparatide, romosozumab, or Overall, IBD is associated with low bone density and increased fracture risk. Risk factors include chronic active disease, nutritional factors, low physical activity, gut resection, hypogonadism, prolonged and repeated courses of glucocorticoids, and the underlying inflammation. Bone density monitoring is important in those at high risk for low bone density and fracture. It is important to optimize nutritional and weight status, physical activity, limit alcohol intake, and avoid smoking. Calcium and vitamin D supplementation are typically necessary. Those with osteoporosis may require pharmacological therapy with bisphosphonates. Some may require bone anabolic therapy. Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.Defining Difficult-to-Treat Inflammatory Bowel DiseaseAll material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
IBD Inflammatory Bowel Disease (IBD) Bone Density Bone Mineral Density BMD Bones Osteoporosis Osteoporotic Backbone Back Bone Vertebral Column Spinal Column Bone Densitometry Dual Energy X-Ray Absorptiometry Metabolic Bone Disorder Metabolic Bone Disease Disorders Of Bone Mineralization Bone Scan Bone Imaging Fractures Spinal Fractures
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