Bone Health In Patients With Inflammatory Bowel Disease (IBD)

An Overview Of The Epidemiology, Pathogenesis, And Management

Abstract

Metabolic bone disease is prevalent in persons with immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD). Within these conditions the most common are osteoporosis and reduced bone mineral density (BMD), often termed osteopenia in adult patients, and refer to a decreased mineralization of the bone matrix. This decreased mineralization weakens the resistance of the bone to external forces, thus increasing the risk of fractures when external compressive or deforming forces are applied. Osteoporosis is asymptomatic in the absence of a fracture, and diagnosis generally occurs through the use of programmatic screening (most commonly dual energy x-ray absorption [DEXA]) or incidentally following the occurrence of a fracture. Osteoporosis is defined as a DEXA-measured BMD at the lumbar spine or proximal femur which falls more than 2.5 standard deviations below the mean value for healthy young adults (known as a T-score). BMD decreases of a lesser degree (a T-score falling between -1 and -2.5) are referred to as osteopenia. Osteoporosis is a major public health concern, owing to the significant morbidity and mortality that is attributed to fractures. While fractures may represent a time-limited hardship among persons in otherwise good health and function, major osteoporosis-related fractures, especially those of the femur and spine, can lead to permanent disability and premature mortality. In Canada, approximately 150 people per 100,000 suffer a hip fracture per year, which confers a 3-fold higher risk of mortality.