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IBD has been associated with an increased risk of osteoporosis and fracture.1 Current guidelines suggest using dual energy x-ray absorptiometry (DXA) to identify IBD patients with osteoporosis as candidates for possible therapy, but focus on IBD patients with established risk factors (ie, postmenopausal women, hypogonadal men or long term (≥3 month) users of glucocorticoids). While the exact role and timing for DXA in IBD is not fully defined, it is even more controversial to consider when therapeutic intervention is indicated. Among the possible choices, bisphosphonates remain the most commonly prescribed pharmacological osteoporosis intervention. While there is little debate when postmenopausal women have osteoporosis-related fractures or osteoporotic bone mineral density (BMD) (ie, T-scores −2.5 or lower),2 ,3 the use of bisphosphonates when patients with IBD are initiating a limited course of glucocorticoids, when T-scores are not in the osteoporotic range, in men or in premenopausal women, requires greater consideration.
The literature evaluating bisphosphonate therapy in IBD, on balance, suggests a benefit for bisphosphonates for increasing BMD and reducing the risk of vertebral fractures.4 However, the studies of bisphosphonate therapy in IBD are quite heterogeneous. Since the use of bisphosphonates in postmenopausal women is not controversial2 ,3 for postmenopausal women who have IBD, there is an added incentive for the healthcare provider to consider a test (DXA) and treat approach. The use of bisphosphonates in the postmenopausal woman and an older man who is a chronic glucocorticoid user is also not controversial.5 One group investigated the feasibility of using bisphosphonates for short term glucocorticoids and found a benefit over calcium and vitamin D plus placebo.6 However, it is uncertain whether short …
Contributors CNB made the original draft of the manuscript and LET and WDL contributed to editing and developing the concepts for the commentary.
Competing interests CNB is supported in part by the Bingham Chair in Gastroenterology. In the past 2 years he has served as a consultant to or been on the advisory boards of Abbvie Canada, Forest Canada, Hospira, Takeda Canada, Bristol Myers Squibb and Vertex Pharmaceuticals and has received a research grant from Abbvie Canada and an unrestricted educational grant from Aptalis Pharmaceuticals. WDL has served on advisory boards for Novartis, Amgen, Genzyme; received unrestricted research grants from Amgen; and received speaker fees from Amgen. LET has served on an advisory board for Merck Canada.
Provenance and peer review Commissioned; internally peer reviewed.