Original Article

Comparison of the Possible Risk Factors of Bone Mineral Density in Subjects with Ulcerative Colitis and Healthy Subjects

Authors: Gülfem Kaya, MD, Erdem Koçak, MD, Erdem Akbal, MD, Adnan Taş, MD, Seyfettin Köklü, MD

Abstract

Objective: Inflammatory bowel disease (IBD) is a gastrointestinal system disorder with a variety of causes. The prevalence of reduced bone mineral density (BMD) is greater in people with IBD as compared with healthy individuals. In this study, we aimed to investigate the possible risk factors for low BMD in subjects with ulcerative colitis (UC) and in healthy control subjects.


Subjects and Methods: A total of 40 subjects with UC and 29 healthy subjects were enrolled in the study. Age; sex; body mass index; location and duration of disease; current corticosteroid, azathioprine, or other immunosuppressive medications; smoking; consumption of alcohol, milk, and milk products; menstrual pattern in women; and use of vitamin D, calcium, folic acid, multivitamins, and iron preparations were recorded. BMD was measured by dual-energy x-ray absorptiometry at L2-L4 of the spine and the femoral neck.


Results: The BMD of patients was found to be lower than that in the control group. The T andz scores of the lumbar vertebra and femoral neck were normal in 21 subjects (52.5%). A total of 17 (42.5%) subjects had osteopenia, and 2 (5%) subjects had osteoporosis. Parathyroid hormone, 1,25(OH)2 vitamin D3, osteocalcin, and urinary markers were found to be similar in both groups. There were no significant differences between subjects with UC and subjects in the control group according to age, sex, and conventional risk factors.


Conclusions: The BMD of subjects with UC was found to be lower than that in subjects of similar age and sex in the control group. Our findings suggest that that the disease itself is the most important pathogenic factor contributing to low BMD.

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References

1. Liu JB, Gao X, Zhang FB, et al. The risk factor for low bone mineral density in patients with inflammatory bowel disease. Zhonghua Nei Ke Za Zhi 2009;48:833-836.
 
2. Zali M, Bahari A, Firouzi F, et al. Bone mineral density in Iranian patients with inflammatory bowel disease. Int J Colorectal Dis 2006;21:758-766.
 
3. De Silva AP, Karunanayake AL, Dissanayaka TG, et al. Osteoporosis in adult Sri Lankan inflammatory bowel disease patients. World J Gastroenterol 2009;28:3528-3531.
 
4. Tsironi E, Hadjidakis D, Mallas E, et al. Comparison of T- and z-score in identifying risk factors of osteoporosis in inflammatory bowel disease patients. J Musculoskelet Neuronal Interact 2008;8:79-84.
 
5. Ardizzone S, Bollani S, Bettica P, et al. Altered bone metabolism in inflammatory bowel disease: there is a difference between Crohn's disease and ulcerative colitis. J Intern Med 2000;247:63-70.
 
6. Lora FL, Amarante HM, Pisani JC, et al. Bone mineral density evaluation in inflammatory bowel disease patents. Arq Gastroenterol 2005;42:201-205.
 
7. Frei P, Fried M, Hungerbuhler V, et al. Analysis of risk factors for low bone mineral density in inflammatory bowel disease. Digestion 2006;73:40-46.
 
8. Jahnsen J, Falch JA, Aadland E, et al. Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study. Gut 1997;40:313-319.
 
9. Vestergaard P, Krogh K, Rejnmark L, et al. Fracture risk is increased in Crohn's disease, but not in ulcerative colitis. Gut 2000;46:176-181.
 
10. Loftus EV Jr, Achenbach SJ, Sandborn WJ, et al. Risk of fracture in ulcerative colitis: a population-based study from Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2003;1:465-473.
 
11. Bjarnason I, Macpherson A, Buxton-Thomas M, et al. High prevalence of osteoporosis in patients with inflammatory bowel disease and low lifetime intake of corticosteroids. Gastroenterology1993;105:541.
 
12. Pollak RD, Karmeli F, Eliakim R, et al. Femoral neck osteopenia in patients with inflammatory bowel disease. Am J Gastroenterol 1998;93:1483-1490.
 
13. Siffledeen JS, Fedorak RN, Siminoski K, et al. Bones and Crohn's: risk factors associated with low bone mineral density in patients with Crohn's disease. Inflamm Bowel Dis 2004;10:220-228.
 
14. Jahnsen J, Falch JA, Mowinckel P, et al. Bone mineral density in patients with inflammatory bowel disease: a population-based prospective two-year follow-up study. Scand J Gastroenterol 2004;39:145-153.
 
15. Reffitt DM, Meenan J, Sanderson JD, et al. Bone density improves with disease remission in patients with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2003;15:1267-1273.
 
16. Saag KG. Prevention of glucocorticoid-induced osteoporosis. South Med J 2004;97:555-558.
 
17. Hela S, Nihel M, Faten L, et al. Osteoporosis and Crohn's disease. Joint Bone Spine 2005;72:403-407.
 
18. Abitbol V, Roux C, Chaussade S, et al. Metabolic bone assessment in patients with inflammatory bowel disease. Gastroenterology 1995;108:417-422.
 
19. Card T, West J, Hubbard R, et al. Hip fractures in patients with inflammatory bowel disease and their relationship to corticosteroid use: a population based cohort study. Gut 2004;53:251-255.
 
20. Klaus J, Armbrecht G, Steinkamp M, et al. High prevalence of osteoporotic vertebral fractures in patients with Crohn's disease. Gut 2002;51:654-658.
 
21. Meier C, Woitge HW, Witte K, et al. Supplementation with oral vitamin D3 and calcium during winter prevents seasonal bone loss: a randomized controlled open-label prospective trial. J Bone Miner Res2004;19:1221-1230.
 
22. Storm D, Eslin R, Porter ES, et al. Calcium supplementation prevents seasonal bone loss and changes in biochemical markers of bone turnover in elderly New England women: a randomized placebo-controlled trial. J Clin Endocrinol Metab 1998;83:3817-3825.
 
23. Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637-1642.
 
24. Ross PD, Knowlton W. Rapid bone loss is associated with increased levels of biochemical markers.J Bone Miner Res 1998;13:297-302.