Skip to main content
SpringerLink
Log in

Low bone mineral density in patients with inflammatory bowel disease

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

To assess the prevalence and risk factors for low bone mineral density in inflammatory bowel disease, we studied 61 consecutive patients, mean age 36±11 years. Twenty-seven had a Crohn's disease and 34 ulcerative colitis (including 13 with ileoanal anatomosis). Three patients, two women and one man (32, 70, and 45 years old, respectively) had vertebral crush fractures. Bone mineral density measured by dual energy x-ray absorptiometry at spine and femoral level was more than 2sd below normal values in 23% of the patients, all of them having received steroid therapy. Eighteen patients (29%) had never received steroid therapy; their bone mineral density was not different than those who had. Univariate analysis showed a positive correlation between bone mineral density and body weight or oral calcium intakes, and a negative correlation with steroid daily dose. After ileoanal anastomosis, bone mineral density was not different from other groups and showed a positive correlation with time elapsed since coloproctectomy. We concluded that bone mineral density is low in patients with inflammatory bowel disease and exposes them to the risk of bone fracture. Bone mineral density after ileoanal anastomosis may increase with time after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stevenson JC, Lees B, Devenport M, Cust MP, Ganger KF: Determinants of bone density in normal women: risk factors for future osteoporosis? Br Med J 298: 924–928, 1989

    Google Scholar 

  2. Lukert BP, Raisz LG: Glucocorticoid-induced osteoporosis: Pathogenesis and management. Ann Intern Med 112: 352–364, 1990

    Google Scholar 

  3. Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P, Vogt TM, the Study of Osteoporosis Fractures Research Group: Appendicular bone density and age predict hip fracture in women. JAMA 263:665–668, 1990

    Google Scholar 

  4. Compston JE, Judd D, Crawley EO, Evans WD, Evans C, Church HA, Reid EM, Rhodes J: Osteoporosis in patients with inflammatory bowel disease Gut 28: 410–415, 1987

    Google Scholar 

  5. Vogelsang H, Ferenci P, Woloszeznk W, Resch H, Herold C, Frotz S, Gangl A: Bone disease in vitamin D-deficient patients with Crohn's disease. Dig Dis Sci 34: 1094–1099, 1989

    Google Scholar 

  6. Ribot C, Tremollières F, Pouilles JM: Influence of the menopause and aging on spinal density in french women. Bone Mineral 5: 89–97, 1988

    Google Scholar 

  7. Bernades P, Hecketsweiller P, Benozio M, Descos L, Geffroy Y, Hemet J, Loygue J, Modigliani R, Potet F, Weill JP: Proposition d'un système de critères pour le diagnostic des entérocolites inflammatoires cryptogéniques (maladie de Crohn et rectocolite hémorragique). Gastroenterol Clin Biol 2: 1047–1054, 1978

    Google Scholar 

  8. Best WR, Becktel JM, Singleton JW, Kern F: Development of a Crohn's disease activity index. National cooperative Crohn's disease study. Gastroenterology 70: 439–444, 1976

    Google Scholar 

  9. Truelove SC, Witts LJ: Cortisone in ulcerative colitis. Br Med J 2: 1041–1046, 1955

    Google Scholar 

  10. Pera A, Bellando P, Caldera D, Ponti V, Astegiano M, Barletti C, David E, Arrigoni A, Rocca G, Verme G: Colonoscopy in inflammatory bowel disease. Diagnostic accuracy and proposal of an endoscopic score. Gastroenterology 92: 181–185, 1987

    Google Scholar 

  11. Chaussade I, Denizot Y, Valleur P, Nicoli J, Raibaud P, Guerre J, Hautefeuille P, Couturier D, Benveniste J: Presence of PAF-acether in stool of patients with pouch ileo-anal anastomosis and pouchitis. Gastroenterology 100: 1509–1514, 1991

    Google Scholar 

  12. Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, Langer B, Jeejeebhoy KN: Nutritional assessment. A comparison of clinical judgment and objective measurements. N Engl J Med 306: 969–972, 1982

    Google Scholar 

  13. Statistical Bulletin. Metropolitan Life Insurance Co., 58:5, 1977

    Google Scholar 

  14. Dewys WD, Begg C, Lavin PT, Band PR, Bennet JM, Bertino JR, Cohen MH, Douglas HO, Ergstrom PF, Erdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Torney DC: Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group Am J Med 69: 491–497, 1980

    Google Scholar 

  15. Messing B, Pigot F, Rongier M, Morin MC, Ndeindoum U, Rambaud JC: Intestinal absorption of free oral hyperalimentation in the very short bowel syndrome. Gastroenterology 100: 1502–1508, 1991

    Google Scholar 

  16. Harris JA, Benedict FG: Biometric Studies of Basal Metabolism in Man Publication number 279. Washington DC, Carnegie Institution, 1919

    Google Scholar 

  17. Roux C, Listrat V, Fechtenbaum J, Gibeault P, Saba E, Rabourdin JP, Dougados M, Revel M, Amor B: Bone mineral density of the proximal femur measured by dual energy x-ray absorptiometry.In C Christiansen, K Overgaard (ed). Osteoporosis, vol 2. 1990, pp 906–908

  18. Goulding A, Gold E: Effect of chronic prednisolone treatment on bone resorption and bone composition in intact and ovariectomised rats in ovariectomised rats receiving β-estradiol. Endocrinology 122:482–487, 1988

    Google Scholar 

  19. Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ: Differential changes in bone mineral density of the appendicular and axial skeleton with aging. J Clin Invest 67:328–335, 1981

    Google Scholar 

  20. Aiges H, Markowitz J, Rosa J, Daum F: Home nocturnal supplemental nasogastric feedings in growth-retarded adolescents with Crohn's disease. Gastroenterology 97:905–910, 1989

    Google Scholar 

  21. Kelts DG, Grand RJ, Shen G, Watkins JB, Werlin SL, Boehme C: Nutritional basis of growth failure in children and adolescents with Crohn's disease. Gastroenterology 76:720–727, 1979

    Google Scholar 

  22. Kirschner BS, Klich JR, Kalman SS, De Favaro MV, Rosenberg IH: Reversal of growth retardation in Crohn's disease with therapy emphasizing oral nutritional resitution. Gastroenterology 80:10–15, 1981

    Google Scholar 

  23. Lauritsen K, Laursen LS, Bukhave K, Rask-Madsen J: Use of colonic eicosanoid concentrations as predictors of relapse in ulcerative colitis: Double blind placebo controlled study on sulphasalazine maintenance treatment. Gut 29:1316–1321, 1988

    Google Scholar 

  24. Motley RJ, Crawley EO, Evans J, Rhodes J, Compston JE; Increased rate of spinal trabecular bone loss in patients with inflammatory bowel disease. Gut 29:1332–1336, 1988

    Google Scholar 

  25. Sambrook P, Birmingham J, Kempler S, Kelly P, Eberl S, Pocock N, Yeates M, Eisman J: Corticosteroid effects on proximal femur bone loss. J Bone Min Res 5:1211–1216, 1990

    Google Scholar 

  26. Adinoff AD, Hollister JR: Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med 309:265–268, 1983

    Google Scholar 

  27. Dykman TR, Gluck OS, Murphy WA, Hahn JJ, Hahn BH: Evaluation of factors associated with glucocorticoid-induced osteopenia with rheumatic diseases. Arthritis Rheum 28:361–368, 1985

    Google Scholar 

  28. Sambrook PN, Eisman JA, Yeates MG, Pocock NA, Eberl S, Champion GD: Osteoporosis in rheumatoid arthritis: Safety of low dose corticosteroids. Ann Rheum Dis 45:950–953, 1986

    Google Scholar 

  29. Rannem T, Hegnho JJ, Hylander E, Kirkegaard P, Thale M, Jarnum S: Absorption studies following ileal J-pouch anastomosis for ulcerative colitis. Eur J Gastroenterol Hepatol 3:201–206, 1991

    Google Scholar 

  30. Pocock NA, Eisman JA, Dunstan CR, Evans RA, Thomas DH, Huq NL: Recovery from steroid-induced osteoporosis. Ann Intern Med 107:319–323, 1987

    Google Scholar 

  31. Hui SL, Slemenda CW, Johnston CC: Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 81:1804–1809, 1988

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d'hépato-gastroentérologie Clinique de Rhumatologie, Hôpital Cochin, 27, rue du Faubourg Saint Jacques, 75674, Paris Cedex 14, France

    François Pigot MD, Christian Roux MD,  Stanislas Chaussade MD, Daniel Hardelin MD, Odette Pelleter, Thierry Du Puy Montbrun MD, Veronique Listrat MD, Maxime Dougados MD, Daniel Couturier MD & Bernard Amor MD

  2. Hôpital Léopold Bellan, Université René Descartes, Paris, France

    François Pigot MD, Christian Roux MD,  Stanislas Chaussade MD, Daniel Hardelin MD, Odette Pelleter, Thierry Du Puy Montbrun MD, Veronique Listrat MD, Maxime Dougados MD, Daniel Couturier MD & Bernard Amor MD

Authors
  1. François Pigot MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Roux MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stanislas Chaussade MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Hardelin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Odette Pelleter
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thierry Du Puy Montbrun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Veronique Listrat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maxime Dougados MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Daniel Couturier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bernard Amor MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pigot, F., Roux, C., Chaussade, S. et al. Low bone mineral density in patients with inflammatory bowel disease. Digest Dis Sci 37, 1396–1403 (1992). https://doi.org/10.1007/BF01296010

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01296010

Key words

Search

Navigation