Osteoporosis and Determinants of Bone Density in Patients with Crohn's Disease
- 116 Downloads
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.
Unable to display preview. Download preview PDF.
- 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.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
- 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
- 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
- 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.Lennard-Jones JE: Classifi cation of inflammatory bowel disease. Scand J Gastroente rology 24 (suppl 170):2- 15, 1989Google Scholar
- 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.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
- 19.Harve y RF, Bradshaw JM: A simple index of Crohn's disease activity. Lancet 0:514, 1980Google Scholar
- 20.Lohman TG, Polhe AF, Martell R: Anthropometric Standardisation Re ference Manual. Human Kine tics Publishers, 1988Google Scholar
- 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.Bernstein CN: Determinants of bone density in inflammatory bowel disease. Gastroenterology 108:1608 - 1609, 1995Google Scholar