Are Patients With IBD at Higher Risk for Osteoporosis?
Are patients with inflammatory bowel disease at higher risk for osteoporosis, and if so, should all be screened?
Osteoporosis is a common problem in patients with inflammatory bowel disease (IBD). As many as 80% of these patients also have either osteopenia or osteoporosis with concomitant fracture risk. It is important for physicians to understand the magnitude of this risk, to test the appropriate patients with dual-energy x-ray absorptiometry (DEXA), and to treat patients appropriately.
Risk factors for osteoporosis in the general population include:
Risk factors specific to IBD include:
The American College of Gastroenterology and the American Gastroenterological Association have published guidelines that identify which patients with IBD should be tested with DEXA. This group includes patients with 1 or more of the following risk factors:
In our practice, 59% of patients had 1 or more risk factors, yet DEXA was performed in only 26% of these patients. Of those with a risk factor who were tested, 71% had low bone mineral density that necessitated treatment. We also determined that by adding low BMI to the list of IBD-related risk factors that should prompt DEXA, nearly all patients with low bone mineral density would have been detected.
All patients with low bone mineral density should be taking vitamin D and calcium supplements and increase their sunlight exposure to raise vitamin D levels. Adding other medications, such as bisphosphonates or selective estrogen-receptor modulators, depends on the outcomes of testing.
Low bone mineral density, osteoporosis, and osteopenia are important problems for patients with IBD. Many patients who should be tested with DEXA are not and therefore are not receiving therapy to reduce fracture risk. Improved awareness is needed among physicians and patients about this complication of IBD.
Question
Are patients with inflammatory bowel disease at higher risk for osteoporosis, and if so, should all be screened?
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Response from Bret A. Lashner, MD Professor of Medicine, Cleveland Clinic, Cleveland, Ohio |
Osteoporosis is a common problem in patients with inflammatory bowel disease (IBD). As many as 80% of these patients also have either osteopenia or osteoporosis with concomitant fracture risk. It is important for physicians to understand the magnitude of this risk, to test the appropriate patients with dual-energy x-ray absorptiometry (DEXA), and to treat patients appropriately.
Risk factors for osteoporosis in the general population include:
Age older than 60 years;
Cigarette smoking (patients with Crohn disease are more likely to smoke than the general population);
Postmenopausal state; and
Body mass index (BMI) < 21 kg/m.
Risk factors specific to IBD include:
Steroid use;
Malnutrition;
Extensive small bowel resection;
Vitamin D deficiency; and
Excess of pro-inflammatory cytokines.
The American College of Gastroenterology and the American Gastroenterological Association have published guidelines that identify which patients with IBD should be tested with DEXA. This group includes patients with 1 or more of the following risk factors:
Postmenopausal state;
Ongoing steroid use;
Previous steroid use of at least 3 months' duration;
History of low-trauma fracture; and
Age older than 60 years.
In our practice, 59% of patients had 1 or more risk factors, yet DEXA was performed in only 26% of these patients. Of those with a risk factor who were tested, 71% had low bone mineral density that necessitated treatment. We also determined that by adding low BMI to the list of IBD-related risk factors that should prompt DEXA, nearly all patients with low bone mineral density would have been detected.
All patients with low bone mineral density should be taking vitamin D and calcium supplements and increase their sunlight exposure to raise vitamin D levels. Adding other medications, such as bisphosphonates or selective estrogen-receptor modulators, depends on the outcomes of testing.
Low bone mineral density, osteoporosis, and osteopenia are important problems for patients with IBD. Many patients who should be tested with DEXA are not and therefore are not receiving therapy to reduce fracture risk. Improved awareness is needed among physicians and patients about this complication of IBD.
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