Bone alterations in young IBD patients tied to increased fracture risk

Reuters Health Information: Bone alterations in young IBD patients tied to increased fracture risk

Bone alterations in young IBD patients tied to increased fracture risk

Last Updated: 2017-06-16

By Anne Harding

NEW YORK (Reuters Health) - Young people with inflammatory bowel disease show changes in trabecular and cortical bone volumetric density (vBMD) and bone microarchitecture that are independently associated with fracture, new research shows.

“Considering that the mean age of our study subjects was 23 years, these results suggest that the magnitude of skeletal alterations in young adults, who develop IBD during childhood and adolescence, may be equivalent to those observed in women 10 years after menopause,” Dr. Jessica Pepe of Geneva University Hospitals in Switzerland told Reuters Health by email.

Patients with IBD are known to have low areal bone mineral density (aBMD), but data are lacking on whether IBD is associated with increased fracture risk, Dr. Pepe and her team note in their report, online May 29 in Inflammatory Bowel Diseases.

Studies to date have relied on dual-energy x-ray absorptiometry (DXA), which can’t tell the difference between cortical and trabecular bone, and does not estimate true bone density, especially in children with small bones, they add.

In previous research, Dr. Pepe and her team used high-resolution peripheral quantitative computed tomography (HR-pQCT) to scan the bones of healthy young people, and found changes in vBMD and microarchitecture were associated with fractures. In the new study, the researchers used HR-pQCT to assess bone structure in 102 IBD patients, most of whom had Crohn’s disease, and 389 healthy controls.

Thirty-seven of the IBD patients had clinical fractures, most involving the forearm, and five had morphometric vertebral fractures.

Tibia trabecular vBMD, thickness and distribution were significantly associated with fractures, but aBMD was not. Distribution of trabecular bone in the radius, tibia vBMD, and trabecular thickness were each independently associated with fractures.

The patients had lower aBMD at all sites than the controls, and alterations in trabecular vBMD and microstructure in the distal radius and tibia that were associated with IBD severity.

“We identified both nutritional and disease-related factors influencing bone microstructure in these patients,” Dr. Pepe told Reuters Health. “Hence, these new findings not only provide better understanding of the cause for increased bone fragility in IBD, but potential targets for interventions in order to prevent fracture in this disease.”

To promote stronger bones in IBD patients, she added, physicians should counsel them on physical activity, smoking cessation and excess alcohol consumption, and minimize corticosteroid treatment. Patients should also consume more than one gram of dietary calcium daily, and should receive supplements if they have low vitamin D levels or low dietary calcium consumption, Dr. Pepe said.

“Improved management and control of this disease has the potential to reduce disease-associated skeletal alterations,” she said.


Inflamm Bowel Dis 2017.

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