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Body composition and muscle strength as predictors of bone mineral density in Crohn’s disease

Journal of Bone and Mineral Metabolism volume 27, pages 456–463 (2009)Cite this article

Abstract

Compromised skeletal status is a frequent finding in patients with Crohn’s disease (CD), leading to increased fracture risk. Low body weight is associated with bone mineral density (BMD) in CD, although the relative importance of its components, lean and fat mass, is unclear. Muscle strength is also a predictor of BMD in nondiseased populations; however, its association with bone in CD is unknown. We examined the independent effects of body composition and muscle strength on regional and whole-body BMD in a cohort of CD patients. Sixty men and women, aged 22–72 years, with disease duration of 13 ± 7 years, underwent scanning of the spine, hip, forearm, and whole-body BMD by dual-energy X-ray absorptiometry (DXA). Lean tissue, appendicular muscle mass (AMM), and fat mass were derived by DXA and grip strength by dynamometry. Medical history, medication usage, clinical variables, and nutritional intake were obtained by questionnaire. Prevalence of osteopenia and osteoporosis was 32 and 17%, respectively, with osteopenia more common at the hip and osteoporosis more common at the spine. In multiple regression analyses, AMM was an independent predictor of whole-body and regional BMD whereas lean mass was an independent predictor at the hip. Neither grip strength nor fat mass was independently associated with BMD. Of the components of body composition, muscle mass was strongly associated with regional and whole-body BMD. Preserving or augmenting muscle mass in this population may be a useful strategy to preserve BMD and thereby reduce fracture risk.

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References

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

    PubMed  CAS  Google Scholar 

  2. Lee N, Radford-Smith G, Taaffe DR (2005) Bone loss in Crohn’s disease: exercise as a potential countermeasure. Inflamm Bowel Dis 11:1108–1118

    PubMed  Article  Google Scholar 

  3. Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN (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 

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

    PubMed  Article  CAS  Google Scholar 

  5. Vestergaard P, Krogh K, Rejnmark L, Laurberg S, Mosekilde L (2000) Fracture risk is increased in Crohn’s disease, but not in ulcerative colitis. Gut 246:176–181

    Article  Google Scholar 

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

    PubMed  Article  Google Scholar 

  7. 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

    PubMed  Article  Google Scholar 

  8. Dinca M, Fries W, Luisetto G, Peccolo F, Bottega F, Leone L, Naccarato R, Martin A (1999) Evolution of osteopenia in inflammatory bowel disease. Am J Gastroenterol 94:1292–1297

    PubMed  Article  CAS  Google Scholar 

  9. 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. Am J Gastroenterol 94:824–828

    PubMed  Article  CAS  Google Scholar 

  10. Habtezion A, Silverberg MS, Parkes R, Mikolainis S, Steinhart AH (2002) Risk factors for low bone density in Crohn’s disease. Inflamm Bowel Dis 8:87–92

    PubMed  Article  Google Scholar 

  11. Robinson RJ, al-Azzawi F, Iqbal SJ, Kryswcki T, Almond L, Abrams K, Mayberry JF (1998) Osteoporosis and determinants of bone density in patients with Crohn’s disease. Dig Dis Sci 143:2500–2506

    Article  Google Scholar 

  12. Vogelsang H, Ferenci P, Resch H, Kiss A, Gangl A (1995) Prevention of bone mineral loss in patients with Crohn’s disease by long-term oral vitamin D supplementation. Eur J Gastroenterol Hepatol 7:609–614

    PubMed  CAS  Google Scholar 

  13. de Jong DJ, Corstens FH, Mannaerts L, van Rossum LG, Naber AH (2002) Corticosteroid-induced osteoporosis: does it occur in patients with Crohn’s disease? Am J Gastroenterol 97:2011–2015

    PubMed  Article  Google Scholar 

  14. Staun M, Tjellesen L, Thale M, Schaadt O, Jarnum S (1997) Bone mineral content in patients with Crohn’s disease. A longitudinal study in patients with bowel resections. Scand J Gastroenterol 32:226–232

    PubMed  Article  CAS  Google Scholar 

  15. Tjellesen L, Nielsen PK, Staun M (1998) Body composition by dual-energy X-ray absorptiometry in patients with Crohn’s disease. Scand J Gastroenterol 33:956–960

    PubMed  Article  CAS  Google Scholar 

  16. Taaffe DR, Cauley JA, Danielson M, Nevitt MC, Lang TF, Bauer DC, Harris TB (2001) Race and sex effects on the association between muscle strength, soft tissue, and bone mineral density in healthy elders: the health, aging, and body composition study. J Bone Miner Res 16:1343–1352

    PubMed  Article  CAS  Google Scholar 

  17. Snow-Harter C, Bouxsein M, Lewis B, Charette S, Weinstein P, Marcus R (1990) Muscle strength as a predictor of bone mineral density in young women. J Bone Miner Res 5:589–595

    PubMed  CAS  Google Scholar 

  18. Burr DB (1997) Muscle strength, bone mass, and age-related bone loss. J Bone Miner Res 12:1547–1551

    PubMed  Article  CAS  Google Scholar 

  19. Frost HM (1997) On our age-related bone loss: insights from a new paradigm. J Bone Miner Res 12:1539–1546

    PubMed  Article  CAS  Google Scholar 

  20. Frost HM (2000) Muscle, bone, and the Utah paradigm: a 1999 overview. Med Sci Sports Exerc 32:911–917

    PubMed  Article  CAS  Google Scholar 

  21. Kritz-Silverstein D, Barrett-Connor E (1994) Grip strength and bone mineral density in older women. J Bone Miner Res 9:45–51

    PubMed  CAS  Google Scholar 

  22. Lennard-Jones JE (1989) Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl 170:2–6

    PubMed  Article  CAS  Google Scholar 

  23. Kanis JA, Melton LJ, Christiansen C, Johnston CC, Khaltaev N (1994) The diagnosis of osteoporosis. J Bone Miner Res 9:1137–1141

    PubMed  CAS  Google Scholar 

  24. Visser M, Pahor M, Taaffe DR, Goodpaster BH, Simonsick EM, Newman AB, Nevitt M, Harris TB (2002) Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the health ABC study. J Gerontol A Biol Sci Med Sci 57:326–332

    Google Scholar 

  25. Carmelli D, Reed T (2000) Stability and change in genetic and environmental influences on hand-grip strength in older male twins. J Appl Physiol 89:1879–1883

    PubMed  CAS  Google Scholar 

  26. Reid IR, Ames R, Evans MC, Sharpe S, Gamble G, France JT, Lim TM, Cundy TF (1992) Determinants of total body and regional bone mineral density in normal postmenopausal women: a key role for fat mass. J Clin Endocrinol Metab 75:45–51

    PubMed  Article  CAS  Google Scholar 

  27. Chatterjee S, Price B (1991) Regression analysis by example, 2nd edn. Wiley, New York

    Google Scholar 

  28. Schulte C, Dignass AU, Mann K, Goebell H (1998) Reduced bone mineral density and unbalanced bone metabolism in patients with inflammatory bowel disease. Inflamm Bowel Dis 4:268–275

    PubMed  Article  CAS  Google Scholar 

  29. Siffiledeen JS, Fedorak RN, Siminoski K, Jen H, Vaudan E, Abraham N, Seinhart H, Greenberg G (2004) Bones and Crohn’s: risk factors associated with low bone mineral density in patients with Crohn’s disease. Inflamm Bowel Dis 10:220–228

    Article  Google Scholar 

  30. Parfitt AM (2001) Skeletal heterogeneity and the purposes of bone remodeling: implications for the understanding of bone remodeling. In: Marcus R, Feldman D, Kelsey J (eds) Osteoporosis. Academic Press, San Diego

    Google Scholar 

  31. Mauro M, Armstrong D (2007) Evaluation of densitometric bone–muscle relationships in Crohn’s disease. Bone NY 40:1610–1614

    Article  CAS  Google Scholar 

  32. Pigot F, Roux C, Chaussade S, Hardelin D, Pelleter O, Du Puy Montbrun T, Listrat V, Dougados M, Couturier D, Amor B (1992) Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci 37:1396–1403

    PubMed  Article  CAS  Google Scholar 

  33. Haugeberg G, Vetvik K, Stallemo A, Bitter H, Mikkelsen B, Stokkeland M (2001) Bone density reduction in patients with Crohn disease and associations with demographic and disease variables: cross-sectional data from a population-based study. Scand J Gastroenterol 36:759–765

    PubMed  Article  CAS  Google Scholar 

  34. Aloia JF, McGowan DM, Vaswani AN, Ross P, Cohn SH (1991) Relationship of menopause to skeletal and muscle mass. Am J Clin Nutr 53:1378–1383

    PubMed  CAS  Google Scholar 

  35. Aloia JF, Vaswani A, Ma R, Flaster E (1995) To what extent is bone mass determined by fat-free or fat mass? Am J Clin Nutr 61:1110–1114

    PubMed  CAS  Google Scholar 

  36. Chen Z, Lohman TG, Stini WA, Ritenbaugh C, Aickin M (1997) Fat or lean tissue mass: which one is the major determinant of bone mineral mass in healthy postmenopausal women? J Bone Miner Res 12:144–151

    PubMed  Article  CAS  Google Scholar 

  37. Reid IR, Evans MC, Ames RW (1994) Volumetric bone density of the lumbar spine is related to fat mass but not lean mass in normal postmenopausal women. Osteoporos Int 4:362–367

    PubMed  Article  CAS  Google Scholar 

  38. Reid IR, Plank LD, Evans MC (1992) Fat mass is an important determinant of whole body bone density in premenopausal women but not in men. J Clin Endocrinol Metab 75:779–782

    PubMed  Article  CAS  Google Scholar 

  39. Compston JE, Bhambhani M, Laskey MA, Murphy S, Khaw KT (1992) Body composition and bone mass in post-menopausal women. Clin Endocrinol (Oxf) 37:426–431

    Article  CAS  Google Scholar 

  40. Lu TW, Taylor SJ, O’Connor JJ, Walker PS (1997) Influence of muscle activity on the forces in the femur: an in vivo study. J Biomech 30:1101–1106

    PubMed  Article  CAS  Google Scholar 

  41. Rubiano F, Nunez C, Heymsfield SB (2000) A comparison of body composition techniques. Ann N Y Acad Sci 904:335–338

    PubMed  CAS  Article  Google Scholar 

  42. Humphries IR, Hua V, Ban L, Gaskin KJ, Howman-Giles R (2000) Validation of estimates of lean tissue mass made by dual-energy X-ray absorptiometry. Ann N Y Acad Sci 904:104–106

    PubMed  CAS  Google Scholar 

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Acknowledgments

Ms. Naomi Lee is supported by an Australian National Ph.D. Scholarship, and Associate Professor Graham Radford-Smith is supported by a Smart State Fellowship from the Queensland Government.

Author information

Affiliations

  1. School of Human Movement Studies, Faculty of Health Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia

    Naomi Lee & Dennis R. Taaffe

  2. Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia

    Graham L. Radford-Smith

  3. School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia

    Mark Forwood

  4. School of Medicine, The University of Queensland, Brisbane, QLD, Australia

    Joseph Wong

Authors
  1. Naomi Lee
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  2. Graham L. Radford-Smith
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  3. Mark Forwood
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  4. Joseph Wong
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  5. Dennis R. Taaffe
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Corresponding author

Correspondence to Dennis R. Taaffe.

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Lee, N., Radford-Smith, G.L., Forwood, M. et al. Body composition and muscle strength as predictors of bone mineral density in Crohn’s disease. J Bone Miner Metab 27, 456–463 (2009). https://doi.org/10.1007/s00774-009-0059-5

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  • DOI: https://doi.org/10.1007/s00774-009-0059-5

Keywords

  • Crohn’s disease
  • Muscle mass
  • Fat mass
  • BMD