Skip to main content

Advertisement

SpringerLink
Log in

Ileum resection is the most predictive factor for osteoporosis in patients with Crohn’s disease

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Introduction

Crohn’s disease is associated with a host of factors potentially increasing the risk for osteoporosis and fractures. The aim of our study was to identify the most predictive factors for skeletal pathology in this patients.

Methods

Using a cross-sectional study design, 146 randomly selected patients with Crohn’s disease of variable disease activity who were given standard therapy to control disease activity, including glucocorticoids, and who attended the outpatient clinic of the Gastroenterology Unit on regular follow-up visits were studied. Bone mineral density (BMD) measurements and lateral X-rays of the spine were performed, and biochemical parameters of bone turnover, gonadal hormones and C-reactive protein (CRP) as markers of disease activity were measured in all patients.

Results

There were 61 men and 85 women, with a mean age of 43 years and mean disease duration of 20 years. The majority of patients (86%) had been treated with glucocorticoids at some stage during their illness at a median dose of 7.5 mg/day, 43% were currently using these agents and 66% had undergone an intestinal resection. Twenty-one percent of patients had below-normal 25-hydroxy vitamin D levels. Osteoporosis was documented in 26% of patients, predominantly at the femoral neck, but also at the lumbar spine or at both sites; osteopenia was documented in 45% of patients. Prevalence of vertebral and non-vertebral fractures was, respectively, 6% and 12%. Ileum resection was the most predictive factor for osteoporosis: RR 3.84 (CI 1.24–9.77, p=0.018), followed by age: RR 1.05 (CI 1.02–1.08, p<0.001) and current or past glucocorticoid use: RR 1.94 (CI 0.92–4.10, p=0.08).

Conclusion

Our data suggest that in patients with Crohn’s disease, the risk of osteoporosis is best predicted by a history of ileum resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. MacDonald TT, Murch SH, Nicholls SW, Breese E (1993) Intestinal cytokines in inflammatory bowel disease and invasive diarrhea. Trans R Soc Trop Med Hyg 87:23–26

    Article  PubMed  Google Scholar 

  2. Vogelsang H, Ferenci P, Woloszczuk W et al (1989) Bone disease in vitamin D–deficient patients with Crohn’s disease. Dig Dis Sci 34:1094–1099

    Article  PubMed  CAS  Google Scholar 

  3. Andreassen H, Hylander E, Rix M (1999) Gender, age, and body weight are the major predictive factors for bone mineral density in Crohn’s disease: A case-control cross-sectional study of 113 patients. Amer J Gastroenterol 94:824–828

    Article  CAS  Google Scholar 

  4. Bernstein CN, Seeger LL, Sayre JW, Anton PA, Artinian L, Shanahan F (1995) Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res 10:250–256

    PubMed  CAS  Google Scholar 

  5. Bernstein CN, Blanchard JF, Metge C et al (2003) The association between corticosteroid use and development of fractures among IBD patients in a population-based database. Am J Gastroenterol 98:1797–1801

    Article  PubMed  Google Scholar 

  6. Boot AM, Bouquet J, Krenning EP, Keizer-Schrama SMPFD (1998) Bone mineral density and nutritional status in children with chronic inflammatory bowel disease. Gut 42:188–194

    Article  PubMed  CAS  Google Scholar 

  7. Compston JE, Judd D, Crawley EO et al (1987) Osteoporosis in patients with inflammatory bowel disease. Gut 28:410–415

    Article  PubMed  CAS  Google Scholar 

  8. Robinson RJ, Alazzawi F, Iqbal SJ et al (1998) Osteoporosis and determinants of bone density in patients with Crohn’s disease. Dig Dis Sci 43:2500–2506

    Article  PubMed  CAS  Google Scholar 

  9. Silvennoinen JA, Karttunen TJ, Niemela SE, Manelius JJ, Lehtola JK (1995) A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut 37:71–76

    Article  PubMed  CAS  Google Scholar 

  10. Kanis JA, Johansson H, Oden A et al (2004) A meta-analysis of prior corticosteroid use and fracture risk. 19:893–899

    Google Scholar 

  11. van Staa TP, Leufkens HG, Cooper C (2002) The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int 13:777–787

    Article  PubMed  Google Scholar 

  12. Walsh LJ, Lewis SA, Wong CA et al (2002) The impact of oral corticosteroid use on bone mineral density and vertebral fracture. Am J Respir Crit Care Med 166:691–695

    Article  PubMed  Google Scholar 

  13. van Staa TP, Abenhaim L, Cooper C, Zhang B, Leufkens HGM (2002) The use of a large pharmaco-epidemiological database to study exposure to oral corticosteroids and risk of fractures: validation of study population and results. Pharmacoepidemiol Drug Safety 9:359–366

    Article  Google Scholar 

  14. Blake GM, Fogelman I (2002) Bone densitometry, steroids and osteoporosis. Curr Opin Nephrol Hypertens 11:641–664

    Article  PubMed  Google Scholar 

  15. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Use of oral corticosteroids and risk of fractures. J Bone Miner Res 15:993–1000

    Article  PubMed  Google Scholar 

  16. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology 39:1383–1389

    Article  PubMed  Google Scholar 

  17. Reid IR, Veale AG, France JT (1994) Glucocorticoid osteoporosis. J Asthma 31:7–18

    Article  PubMed  CAS  Google Scholar 

  18. Manolagas SC (2000) Corticosteroids and fractures: a close encounter of the third cell kind. J Bone Miner Res 15:1001–1005

    Article  PubMed  CAS  Google Scholar 

  19. Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC (1998) Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest 102:274–282

    Article  PubMed  CAS  Google Scholar 

  20. Loftus EV, Crowson CS, Sandborn WJ et al (2002) Long-term fracture risk in patients with Crohn’s disease: a population-based study in Olmsted County, Minnesota. Gastroenterology 123:46

    Article  Google Scholar 

  21. van Staa TP, Cooper C, Brosse LS, Leufkens H, Javaid MK, Arden NK (2003) Inflammatory bowel disease and the risk of fracture. Gastroenterology 125:1591–1597

    Article  PubMed  Google Scholar 

  22. Card T, West J, Hubbard R, Logan F (2004) Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population-based study. Gut 53:251–255

    Article  PubMed  CAS  Google Scholar 

  23. Klaus J, Armbrecht G, Steinkamp M et al (2002) High prevalence of osteoporotic vertebral fractures in patients with Crohn’s disease. Gut 51(5):654–658

    Article  PubMed  CAS  Google Scholar 

  24. Bernstein CN, Blanchard JF, Leslie W et al (2000) The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med 133:795–799

    PubMed  CAS  Google Scholar 

  25. Vestergaard P, Mosekilde L (2000) Fracture risk is increased in Crohn’s disease, but not ulcerative colitis. Gut 46:176–181

    Article  PubMed  CAS  Google Scholar 

  26. Robinson RJ, Iqbal SJ, Abrams K, Alazzawi F, Mayberry JF (1998) Increased bone resorption in patients with Crohn’s disease. Aliment Pharmacol Therapeut 12:699–705

    Article  CAS  Google Scholar 

  27. Bjarnason I, Macpherson A, Mackintosh C, Buxtonthomas M, Forgacs I, Moniz C (1997) Reduced bone density in patients with inflammatory bowel disease. Gut 40:228–233

    PubMed  CAS  Google Scholar 

  28. Compston J (2003) Osteoporosis in inflammatory bowel disease. Gut 52:63–64

    Article  PubMed  CAS  Google Scholar 

  29. Dear KL, Compston JE, Hunter JO (2001) Treatments for Crohn’s disease that minimise steroid doses are associated with a reduced risk of osteoporosis. Clin Nutr 20:541–546

    Article  PubMed  CAS  Google Scholar 

  30. Schoon EJ, Blok BM, Geerling BJ, Russel MG, Stockbrugger RW, Brummer RJM (2000) Bone mineral density in patients with recently diagnosed inflammatory bowel disease. Gastroenterology 119:1203–1208

    Article  PubMed  CAS  Google Scholar 

  31. Vestergaard P, Mosekilde L (2002) Fracture risk in patients with Celiac disease, Crohn’s disease, and Ulcerative Colitis: a nationwide follow-up study of 16,416 patients in Denmark. Am J Epidemiol 156:1–10

    Article  PubMed  Google Scholar 

  32. Schulte C, Dignass AU, Mann K, Goebell H (1999) Bone loss in patients with inflammatory bowel disease is less than expected: A follow-up study. Scand J Gastroenterol 34:696–702

    Article  PubMed  CAS  Google Scholar 

  33. Clements D, Motley RJ, Evans WD et al (1992) Longitudinal study of cortical bone loss in patients with inflammatory bowel disease. Scand J Gastroenterol 27:1055–1060

    Article  PubMed  CAS  Google Scholar 

  34. Roux C, Abitbol V, Chaussade S et al (1995) Bone loss in patients with inflammatory bowel disease: a prospective study. Osteoporos Int 5:156–160

    Article  PubMed  CAS  Google Scholar 

  35. Jahnsen J, Falch JA, Mowinckel, Aadland E (2004) Bone mineral density in patients with inflammatory bowel disease: A population-based prospective two-year follow-up study. Scand J Gastroenterol 39:145–153

    Article  PubMed  CAS  Google Scholar 

  36. Papapoulos SE (2001) Bisphosphonates in the management of postmenopausal osteoporosis. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis. Academic Press, Orlando, Florida, U.S.A. pp 631–650

    Chapter  Google Scholar 

  37. Ringe JD, Faber H, Dorst A (2001) Alendronate treatment of established primary osteoporosis in men: results of a 2-year prospective study. J Clin Endocrinol Metab 86:5252–5255

    Article  PubMed  CAS  Google Scholar 

  38. Gonnelli S, Cepollaro C, Montagnani A et al (2003) Alendronate Treatment in Men With Primary Osteoporosis: a three-year longitudinal study. Calcif Tissue Int 73:133–139

    Article  PubMed  CAS  Google Scholar 

  39. Saag KG, Emkey R, Schnitzer JP et al (1998) Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 339:292–299

    Article  PubMed  CAS  Google Scholar 

  40. Reid DM, Hughes RA, Laan RF et al (2000) Efficacy and safety of daily risedronate in the treatment of corticosteroid-induced osteoporosis in men and women: a randomized trial. J Bone Miner Res 15:1006–1013

    Article  PubMed  CAS  Google Scholar 

  41. Cohen D, Adachi JA (2004) The treatment of glucocorticoid-induced osteoporosis. J Steroid Biochem Mol Biol 88:337–349

    Article  PubMed  CAS  Google Scholar 

  42. Harrison J, Hanauer SB (2002) Medical treatment of Crohn’s disease. Gastroenterol Clin North Am 31:167–184

    Article  PubMed  Google Scholar 

  43. Wahner HW, Looker A, Dunn WL, Walters LC, Hauser MF, Novak C (1994) Quality control of bone densitometry in a national health survey (NHANES III) using three mobile examination centers. J Bone Miner Res 9:951–960

    PubMed  CAS  Google Scholar 

  44. Genant HK, Grampp S, Gluer CC, Faulkner KG, Jergas M, Engelke K, Hagiwara S, Van Kuijk C (1994) Universal standardization for dual X–ray absorptiometry: patient and phantom cross-calibration results. J Bone Miner Res 9:1503–1514

    Article  PubMed  CAS  Google Scholar 

  45. Staal KP, Roos JC, Manoliu RA, Kostense PJ, Lips P (2004) Variations in diagnostic performances of dual-energy X–ray absorptiometry in the northwest of The Netherlands. Osteoporosis Int 15:335–344

    Article  PubMed  Google Scholar 

  46. World Health Organization (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series 843

  47. McCloskey EV, Spector TD, Eyres KS et al (1993) The assessment of vertebral deformity: a method for use in population studies and clinical trials. Osteoporos Int 3:138–147

    Article  PubMed  CAS  Google Scholar 

  48. Cranney A, Guyatt G, Griffith L, Wells G, Tugwell P, Rosen C (2002) Meta-analyses of therapies for postmenopausal osteoporosis. Summary. Endocr Rev 23:570–578

    Article  PubMed  CAS  Google Scholar 

  49. Pigot F, Roux C, Chaussade S et al (1992) Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci 37:1396–1403

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

    R. A. van Hogezand & G. Griffioen

  2. Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, ZA, The Netherlands

    D. Bänffer & N. A. T. Hamdy

  3. Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands

    A. H. Zwinderman

  4. Metabolic Bone Centre, Northern General Hospital, Sheffield, UK

    E. V. McCloskey

Authors
  1. R. A. van Hogezand
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Bänffer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. H. Zwinderman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. V. McCloskey
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Griffioen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. N. A. T. Hamdy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. A. T. Hamdy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Hogezand, R.A., Bänffer, D., Zwinderman, A.H. et al. Ileum resection is the most predictive factor for osteoporosis in patients with Crohn’s disease. Osteoporos Int 17, 535–542 (2006). https://doi.org/10.1007/s00198-005-0016-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-005-0016-7

Keywords

Search

Navigation