Skip to main content
PMC home page
Gut logoLink to Gut
. 1997 Mar;40(3):313–319. doi: 10.1136/gut.40.3.313

Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study.

J Jahnsen 1, J A Falch 1, E Aadland 1, P Mowinckel 1
PMCID: PMC1027079  PMID: 9135518

Abstract

BACKGROUND: Patients with inflammatory bowel disease are at risk of developing metabolic bone disease. AIMS: To compare bone mineral density in patients with Crohn's disease with patients with ulcerative colitis and healthy subjects, and to evaluate possible risk factors for bone loss in inflammatory bowel disease. PATIENTS: 60 patients with Crohn's disease, 60 with ulcerative colitis, and 60 healthy subjects were investigated. Each group consisted of 24 men and 36 women. METHODS: Lumbar spine, femoral neck, and total body bone mineral density were measured by dual x ray absorptiometry (DXA), and Z scores were obtained by comparison with age and sex matched normal values. RESULTS: Mean Z scores were significantly lower in patients with Crohn's disease compared with patients with ulcerative colitis and healthy subjects. Patients with ulcerative colitis had bone mineral densities similar to healthy subjects. Use of corticosteroids, body mass index (BMI), and sex were significant predictor variables for bone mineral density in Crohn's disease. In ulcerative colitis only body mass index and sex were of significant importance. Disease localisation and small bowel resections had no influence on bone mineral density in patients with Crohn's disease. CONCLUSIONS: Patients with Crohn's disease have reduced bone mineral density. Several factors are probably involved, but the reduction is associated with corticosteroid therapy. When studying skeletal effects of inflammatory bowel disease, patients with Crohn's disease and those with ulcerative colitis should be evaluated separately.

Full text

PDF
313

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abitbol V., Roux C., Chaussade S., Guillemant S., Kolta S., Dougados M., Couturier D., Amor B. Metabolic bone assessment in patients with inflammatory bowel disease. Gastroenterology. 1995 Feb;108(2):417–422. doi: 10.1016/0016-5085(95)90068-3. [DOI] [PubMed] [Google Scholar]
  2. Adler R. A., Rosen C. J. Glucocorticoids and osteoporosis. Endocrinol Metab Clin North Am. 1994 Sep;23(3):641–654. [PubMed] [Google Scholar]
  3. Bernstein C. N., Seeger L. L., Sayre J. W., Anton P. A., Artinian L., Shanahan F. Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res. 1995 Feb;10(2):250–256. doi: 10.1002/jbmr.5650100211. [DOI] [PubMed] [Google Scholar]
  4. Bernstein C. N., Seeger L. L., Sayre J. W., Anton P. A., Artinian L., Shanahan F. Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis. J Bone Miner Res. 1995 Feb;10(2):250–256. doi: 10.1002/jbmr.5650100211. [DOI] [PubMed] [Google Scholar]
  5. Clements D., Compston J. E., Evans W. D., Rhodes J. Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease. Gut. 1993 Nov;34(11):1543–1546. doi: 10.1136/gut.34.11.1543. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Clements D., Motley R. J., Evans W. D., Harries A. D., Rhodes J., Coles R. J., Compston J. E. Longitudinal study of cortical bone loss in patients with inflammatory bowel disease. Scand J Gastroenterol. 1992 Dec;27(12):1055–1060. doi: 10.3109/00365529209028138. [DOI] [PubMed] [Google Scholar]
  7. Compston J. E., Judd D., Crawley E. O., Evans W. D., Evans C., Church H. A., Reid E. M., Rhodes J. Osteoporosis in patients with inflammatory bowel disease. Gut. 1987 Apr;28(4):410–415. doi: 10.1136/gut.28.4.410. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cummings S. R., Black D. M., Nevitt M. C., Browner W. S., Cauley J. A., Genant H. K., Mascioli S. R., Scott J. C., Seeley D. G., Steiger P. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA. 1990 Feb 2;263(5):665–668. [PubMed] [Google Scholar]
  9. Cummings S. R., Black D. M., Nevitt M. C., Browner W., Cauley J., Ensrud K., Genant H. K., Palermo L., Scott J., Vogt T. M. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993 Jan 9;341(8837):72–75. doi: 10.1016/0140-6736(93)92555-8. [DOI] [PubMed] [Google Scholar]
  10. Edelstein S. L., Barrett-Connor E. Relation between body size and bone mineral density in elderly men and women. Am J Epidemiol. 1993 Aug 1;138(3):160–169. doi: 10.1093/oxfordjournals.aje.a116842. [DOI] [PubMed] [Google Scholar]
  11. Falch J. A., Meyer H. E. Beinmineraltetthet målt med dobbel røntgenabsorpsjonsmetri. Et referansemateriale fra Oslo. Tidsskr Nor Laegeforen. 1996 Aug 20;116(19):2299–2302. [PubMed] [Google Scholar]
  12. Falch J. A., Oftebro H., Haug E. Early postmenopausal bone loss is not associated with a decrease in circulating levels of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, or vitamin D-binding protein. J Clin Endocrinol Metab. 1987 Apr;64(4):836–841. doi: 10.1210/jcem-64-4-836. [DOI] [PubMed] [Google Scholar]
  13. Felson D. T., Zhang Y., Hannan M. T., Anderson J. J. Effects of weight and body mass index on bone mineral density in men and women: the Framingham study. J Bone Miner Res. 1993 May;8(5):567–573. doi: 10.1002/jbmr.5650080507. [DOI] [PubMed] [Google Scholar]
  14. Ghosh S., Cowen S., Hannan W. J., Ferguson A. Low bone mineral density in Crohn's disease, but not in ulcerative colitis, at diagnosis. Gastroenterology. 1994 Oct;107(4):1031–1039. doi: 10.1016/0016-5085(94)90227-5. [DOI] [PubMed] [Google Scholar]
  15. Gut J. P., Auriche M., Spriet-Pourra C., Juillet Y. Etude critique des méthodes de surveillance des médicaments après mise sur le marché. Therapie. 1985 Sep-Oct;40(5):313–319. [PubMed] [Google Scholar]
  16. Hui S. L., Slemenda C. W., Johnston C. C., Jr Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989 Sep 1;111(5):355–361. doi: 10.7326/0003-4819-111-5-355. [DOI] [PubMed] [Google Scholar]
  17. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis. Rheum Dis Clin North Am. 1994 Aug;20(3):629–650. [PubMed] [Google Scholar]
  18. MacDonald B. R., Gowen M. Cytokines and bone. Br J Rheumatol. 1992 Mar;31(3):149–155. doi: 10.1093/rheumatology/31.3.149. [DOI] [PubMed] [Google Scholar]
  19. Motley R. J., Crawley E. O., Evans C., Rhodes J., Compston J. E. Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease. Gut. 1988 Oct;29(10):1332–1336. doi: 10.1136/gut.29.10.1332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Nielsen H. K., Charles P., Mosekilde L. The effect of single oral doses of prednisone on the circadian rhythm of serum osteocalcin in normal subjects. J Clin Endocrinol Metab. 1988 Nov;67(5):1025–1030. doi: 10.1210/jcem-67-5-1025. [DOI] [PubMed] [Google Scholar]
  21. O'Neill T. W., Felsenberg D., Varlow J., Cooper C., Kanis J. A., Silman A. J. The prevalence of vertebral deformity in european men and women: the European Vertebral Osteoporosis Study. J Bone Miner Res. 1996 Jul;11(7):1010–1018. doi: 10.1002/jbmr.5650110719. [DOI] [PubMed] [Google Scholar]
  22. Pigot F., Roux C., Chaussade S., Hardelin D., Pelleter O., Du Puy Montbrun T., Listrat V., Dougados M., Couturier D., Amor B. Low bone mineral density in patients with inflammatory bowel disease. Dig Dis Sci. 1992 Sep;37(9):1396–1403. doi: 10.1007/BF01296010. [DOI] [PubMed] [Google Scholar]
  23. Puolijoki H., Liippo K., Herrala J., Salmi J., Tala E. Inhaled beclomethasone decreases serum osteocalcin in postmenopausal asthmatic women. Bone. 1992;13(4):285–288. doi: 10.1016/8756-3282(92)90072-5. [DOI] [PubMed] [Google Scholar]
  24. Reid I. R., Evans M. C., Stapleton J. Lateral spine densitometry is a more sensitive indicator of glucocorticoid-induced bone loss. J Bone Miner Res. 1992 Oct;7(10):1221–1225. doi: 10.1002/jbmr.5650071014. [DOI] [PubMed] [Google Scholar]
  25. Reid I. R., Evans M. C., Wattie D. J., Ames R., Cundy T. F. Bone mineral density of the proximal femur and lumbar spine in glucocorticoid-treated asthmatic patients. Osteoporos Int. 1992 Mar;2(2):103–105. doi: 10.1007/BF01623844. [DOI] [PubMed] [Google Scholar]
  26. Ross P. D., Davis J. W., Epstein R. S., Wasnich R. D. Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med. 1991 Jun 1;114(11):919–923. doi: 10.7326/0003-4819-114-11-919. [DOI] [PubMed] [Google Scholar]
  27. Roux C., Abitbol V., Chaussade S., Kolta S., Guillemant S., Dougados M., Amor B., Couturier D. Bone loss in patients with inflammatory bowel disease: a prospective study. Osteoporos Int. 1995 May;5(3):156–160. doi: 10.1007/BF02106094. [DOI] [PubMed] [Google Scholar]
  28. Rüegsegger P., Medici T. C., Anliker M. Corticosteroid-induced bone loss. A longitudinal study of alternate day therapy in patients with bronchial asthma using quantitative computed tomography. Eur J Clin Pharmacol. 1983;25(5):615–620. doi: 10.1007/BF00542348. [DOI] [PubMed] [Google Scholar]
  29. Silvennoinen J. A., Karttunen T. J., Niemelä S. E., Manelius J. J., Lehtola J. K. A controlled study of bone mineral density in patients with inflammatory bowel disease. Gut. 1995 Jul;37(1):71–76. doi: 10.1136/gut.37.1.71. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tromm A., Rickels K., Hüppe D., Wiebe V., May B. Osteopenie bei chronisch entzündlichen Darmerkrankungen. Ergebnisse einer Querschnittsuntersuchung mittels quantitativer Computertomographie. Leber Magen Darm. 1994 Feb;24(1):23-6, 29-30. [PubMed] [Google Scholar]
  31. Vogelsang H., Ferenci P., Woloszczuk W., Resch H., Herold C., Frotz S., Gangl A. Bone disease in vitamin D-deficient patients with Crohn's disease. Dig Dis Sci. 1989 Jul;34(7):1094–1099. doi: 10.1007/BF01536381. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES