Digestive Diseases and Sciences

, Volume 43, Issue 11, pp 2500–2506 | Cite as

Osteoporosis and Determinants of Bone Density in Patients with Crohn's Disease

  • R. J. Robinson
  • F. Al Azzawi
  • S. J. Iqbal
  • T. Kryswcki
  • L. Almond
  • K. Abrams
  • J. F. Mayberry
Article

Abstract

Low bone mineral density (BMD) is common inpatients with Crohn's disease; however, the pathogenesisof bone loss and risk factors for osteoporosis are notestablished. Our aim was to evaluate the clinical, dietary, and nutritional determinants of BMD inCrohn's disease. A cross-sectional analysis of 117patients with Crohn's disease was undertaken. Allpatients underwent a clinical and dietary evaluation including assessment of nutritional state andlife-style. BMD was measured at the hip and lumbar spineby dual-energy x-ray absorptiometry; and z scoresobtained by comparison with age- and sex-matched normal values for the healthy UK population.Multiple regression analysis was used to assessassociations between BMD and potential risk factors,allowing for possible confounding variables. Thirteen(11%) patients had osteoporosis (z score<–2), with osteopenia (z score <–1,>–2) in a further 34 (29%). Patients withjejunal disease had significantly lower BMD at the spine(P = 0.03) and femoral neck (P = 0.02) than those with disease atother sites. Mean BMD was significantly lower at the hipof patients with previous bowel resection (diff in means= 0.53, 95% CI-0.97, –0.08, P = 0.02), but type of surgery was not significant. Active disease,menstrual history, diet, level of physical activity, andsmoking were not associated with low bone mass. At thelumbar spine, body weight (P < 0.0001), male sex (P < 0.0001), and currentprednisolone use (P < 0.02) were independentlypredictive of low bone mass. Body weight (P <0.0001), male sex (P < 0.0001), and cumulativesteroid dose (P = 0.02) were predictive at the femoralneck. The major determinants of BMD in Crohn's diseaseare body weight, current steroid use, and cumulativesteroid dose. Men with Crohn's disease are at greatest risk of osteoporosis, with jejunal involvementand previous bowel resection also contributing to thelow bone mineral density.

CROHN'S DISEASE BONE MINERAL DENSITY ETIOLOGY OSTEOPENIA OSTEOPOROSIS 

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REFERENCES

  1. 1.
    Silvennoinen JA, Karttunen TJ, Niemela SE, Mane lius JJ, Lehtola JK: A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut 37:71- 76, 1995PubMedGoogle Scholar
  2. 2.
    Pigot F, Roux C, Chaussade S, Hardelin D, Pe lleter O, Montbrun TD-P, Listrat V, Dougados M, Couturier D, Amor B: Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci 37:1396 - 1403, 1992PubMedGoogle Scholar
  3. 3.
    Compston JE, Judd D, Crawley EO, Evans WD, Evans C, Church HA, Re id EM, Rhodes J: Osteoporosis in patients with inflammatory bowel disease. Gut 28:410 - 415, 1987PubMedGoogle Scholar
  4. 4.
    Jahnsen J, Falch JA, Aadland E, Mowinckel P: Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: A population based study. Gut 40:313- 319, 1997PubMedGoogle Scholar
  5. 5.
    Bernstein CN, See ger LL, Sayre JW, Anton PA, Artinian L, Shanahan F: Decrease d bone density in inflammatory bowel disease is re lated to corticosteroid use and not disease diagnosis. J Bone Min Res 10 (2):250 - 255, 1995Google Scholar
  6. 6.
    Hylander E, Ladefoged K, Madsen S: Calcium balence and bone mine ral content following small intestinal rese ction. Scand J Gastroenterol 167- 176, 1981Google Scholar
  7. 7.
    Silvennoinen JA, Lehtola JK, Niemela SE: Smoking is a risk factor for osteoporosis in women with inammatory bowel disease. Scand J Gastroenterol 31(4):367- 371, 1996PubMedGoogle Scholar
  8. 8.
    Ghosh S, Cowen S, Hannan WJ, Fe rguson A: Low bone mineral density in Crohn's disease, but not in ulcerative colitis at diagnosis. Gastroente rology 107:1031- 1039, 1994Google Scholar
  9. 9.
    Vogelsang H, Fe renci P, Woloszeznk W, Resch H, Herold C, Frotz S, et al: Bone disease in vitamin D defi cient patients with Crohn's disease. Dig Dis Sci 34:1094 - 1099, 1989PubMedGoogle Scholar
  10. 10.
    Lukert BP, Raisz LG: Glucocorticoid-induced osteoporosis: Pathogene sis and management. Ann Intern Med 112:352- 364, 1990PubMedGoogle Scholar
  11. 11.
    Westarp CV, Thompson ABR, Ove rton TR, Rogers RM, Hodges PE, Fornasier VL, e t al: Disorders of bone and mineral me tabolism in patients with Crohn's disease. Can J Gastroenterol 1:11- 17, 1987Google Scholar
  12. 12.
    Bjarnason I, Macphe rson A, Mackintosh C, Buxton-Thomas M, Forgacs I, Moniiz C: Reduced bone density in patients with inflammatory bowel disease. Gut 40:228 - 233, 1997PubMedGoogle Scholar
  13. 13.
    Motley RJ, Crawley EO, Evans C, Rhodes J, Compston JE: Incre ased rate of spinal trabecular bone loss in patients with inflammatory bowel disease. Gut 29:274 - 282, 1988Google Scholar
  14. 14.
    Lennard-Jones JE: Classifi cation of inflammatory bowel disease. Scand J Gastroente rology 24 (suppl 170):2- 15, 1989Google Scholar
  15. 15.
    Yarnell JW, Fehily AM, Milbank JE, Sweatram PM, Walker CL: A short dietary questionnaire for use in an epidemiological survey: Comparison with weighed dietary records. Hum Nutr Appl Nutr 37( 2):103- 112, 1983PubMedGoogle Scholar
  16. 16.
    Activity and Health Research: Allied Dunbar national fitness survey: A report on activity patterns and fitness levels. London, Sports Council and Health Education Authority 1992Google Scholar
  17. 17.
    Ainsworth BE, Haske ll WL, Leon AS, Jacobs DR, Montoye HJ, Sallis JF, Paffenbarger RS: Compendium of physical activities: Classifi cation of energy costs of human physical activities. Med Sci Sports Exe rcise 25( 1):71- 80, 1993Google Scholar
  18. 18.
    Sinaki M, Offord KP: Physical activity in postmenopausal women: effect on back muscle strength and bone mineral density of the spine. Arch Phys Med Rehabil 69:277- 280, 1988PubMedGoogle Scholar
  19. 19.
    Harve y RF, Bradshaw JM: A simple index of Crohn's disease activity. Lancet 0:514, 1980Google Scholar
  20. 20.
    Lohman TG, Polhe AF, Martell R: Anthropometric Standardisation Re ference Manual. Human Kine tics Publishers, 1988Google Scholar
  21. 21.
    Durnin JVGA, Wome rsley J: Body fat assessed from total body density and its estimation from skinfold thickness: Measure ments on 481 men and women aged from 16 to 72 ye ars. Br J Nutr 32:77- 97, 1974PubMedGoogle Scholar
  22. 22.
    Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al: Bone density at various sites for prediction of hip fracture s. Lancet 341:72- 75, 1993CrossRefPubMedGoogle Scholar
  23. 23.
    Driscoll RH, Meredith SC, Sitrin M, Rosenberg IH: Vitamin D defi ciency and bone disease in patients with Crohn's disease. Gastroene rology 83:1252- 1258, 1982Google Scholar
  24. 24.
    Bernstein CN: Determinants of bone density in inflammatory bowel disease. Gastroenterology 108:1608 - 1609, 1995Google Scholar
  25. 25.
    Mazlam MZ, Hodgson HJF: Pe ripheral blood monocyte cytokine production in inflammatory bowel disease. Gut 33:773- 778, 1992PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • R. J. Robinson
  • F. Al Azzawi
  • S. J. Iqbal
  • T. Kryswcki
  • L. Almond
  • K. Abrams
  • J. F. Mayberry

There are no affiliations available

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