Keywords
inflammatory bowel disease (IBD)
Crohn's disease
ulcerative colitis
dual-energy X-ray absorptiometry (DXA)
How to Cite
Abstract
Secondary osteoporosis consists in the decreased bone mineral density and the alteration of the bone microarchitecture, due to factors other than age and post menopause. These changes lead to an increase in the risk of fragility and subsequent bone fractures. Patients with inflammatory bowel disease have a complex interaction of factors that favor the development of osteoporosis. The identification of the mechanisms triggering osteoporosis in these patients has been a challenge, considering the variety of drugs, conditions and illnesses that merge in the patient with an intestinal inflammatory disease. Understanding risk factors and the importance of physiopathological mechanisms can allow a better preventive and therapeutic approach.
The case of a woman of 59 Years with Ulcerative Colitis since age 18, is presented. The patient was managed with multiple steroid courses, with clinical and paraclinical signs of malnutrition. The patient presented with lumbar pain, which lead to the diagnosis of vertebral fractures. Multiple causal mechanisms of osteoporosis are described in the patient, including premature ovarian failure, vitamin D deficiency, malnutrition and steroid use.
This review focuses on the pathophysiology of osteoporosis secondary to inflammatory bowel disease and its diagnostic and therapeutic approach in the context of an illustrative case.
References
2. Aguirre D, Archila PE, Carrera J, Castaño R, Escobar CM, Garcia, et al. Consenso colombiano de enfermedad inflamatoria intestinal. Rev Colomb Gastroenterol. Asociación Colombiana de Gastroenterolog{\’\i}a; 2012;27:s1-s44.
3. IHME. GBD Compare Data Visualization [Internet]. Seattle, WA: Institute for Health Metrics and Evaluation, University of Washington. 2016 [cited 2019 Mar 25]. Available from: http://vizhub.healthdata.org/gbd-compare
4. Calderón M, Minckas N, Nuñez S, Ciapponi A. Inflammatory Bowel Disease in Latin America: A Systematic Review. Value Heal Reg Issues. 2018 Dec;17:126-34.
5. van Hogezand RA, Hamdy NAT. Skeletal morbidity in inflammatory bowel disease. Scand J Gastroenterol Suppl. 2006 Jan 8;41(243):59-64.
6. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003 Mar;124(3):795-841.
7. Szafors P, Che H, Barnetche T, Morel J, Gaujoux-Viala C, Combe B, et al. Risk of fracture and low bone mineral density in adults with inflammatory bowel diseases. A systematic literature review with meta-analysis. Osteoporos Int. 2018 Nov 16;29(11):2389-97.
8. Lima CA, Lyra AC, Rocha R, Santana GO. Risk factors for osteoporosis in inflammatory bowel disease patients. World J Gastrointest Pathophysiol. Baishideng Publishing Group Inc; 2015 Nov 15;6(4):210-8.
9. Wei H, Ouyang C, Peng D, Lu F, Zhang J. Osteoporosis as an initial manifestation in a patient with Crohn’s disease: A case report. Exp Ther Med. Spandidos Publications; 2018 Apr;15(4):3997-4000.
10. Kim DH, Cheon JH. Pathogenesis of Inflammatory Bowel Disease and Recent Advances in Biologic Therapies. Immune Netw. The Korean Association of Immunologists; 2017 Feb;17(1):25-40.
11. Sylvester FA. Inflammatory bowel disease: Effects on bone and mechanisms. In: McCabe L, Parameswaran N, editors. Advances in Experimental Medicine and Biology. Springer; 2017. p. 133-50.
12. Lima CA. Risk factors for osteoporosis in inflammatory bowel disease patients. World J Gastrointest Pathophysiol. 2015;6(4):210.
13. Saag K, Adler RA. Glucocorticoid-Induced Osteoporosis. In: Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism. Wiley; 2018. p. 467-73.
14. Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in Inflammatory Bowel Disease. Am J Med. 2009 Jul;122(7):599-604.
15. Cushing KC, Kordbacheh H, Gee MS, Kambadakone A, Ananthakrishnan AN. Sarcopenia is a Novel Predictor of the Need for Rescue Therapy in Hospitalized Ulcerative Colitis Patients. J Crohn’s Colitis. 2018 May 12;
16. Bryant R V., Trott MJ, Bartholomeusz FD, Andrews JM. Systematic review: body composition in adults with inflammatory bowel disease. Aliment Pharmacol Ther. 2013 Aug;38(3):213-25.
17. Bryant R V., Ooi S, Schultz CG, Goess C, Grafton R, Hughes J, et al. Low muscle mass and sarcopenia: common and predictive of osteopenia in inflammatory bowel disease. Aliment Pharmacol Ther. 2015 May;41(9):895-906.
18. Bryant R, Schultz C, Ooi S, Goess C, Costello S, Vincent A, et al. Obesity in Inflammatory Bowel Disease: Gains in Adiposity despite High Prevalence of Myopenia and Osteopenia. Nutrients. 2018 Sep 1;10(9):1192.
19. Wang P, Hu J, Ghadermarzi S, Raza A, O’Connell D, Xiao A, et al. Smoking and Inflammatory Bowel Disease: A Comparison of China, India, and the USA. Dig Dis Sci. 2018 Oct 4;63(10):2703-13.
20. Parkes GC, Whelan K, Lindsay JO. Smoking in inflammatory bowel disease: Impact on disease course and insights into the aetiology of its effect. J Crohn’s Colitis. Narnia; 2014 Aug 1;8(8):717-25.
21. Farraye FA, Melmed GY, Lichtenstein GR, Kane S V. ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. Am J Gastroenterol. 2017 Feb;112(2):241-58.
22. of Gastroenterology BS, Lewis NR, Scott BB. Guidelines for osteoporosis in inflammatory bowel disease and coeliac disease. British Society of Gastroenterology; 2008.
23. Franchimont N, Putzeys V, Collette J, Vermeire S, Rutgeerts P, De Vos M, et al. Rapid improvement of bone metabolism after infliximab treatment in Crohn’s disease. Aliment Pharmacol Ther. 2004 Sep 15;20(6):607-14.
24. Tindell A, Johnsson H, McInnes IB. Arthritis, Arthropathy, and Osteoporosis in Inflammatory Bowel Disease. In: Crohn’s Disease and Ulcerative Colitis. Cham: Springer International Publishing; 2017. p. 571-83.
25. Piodi LP. Managing osteoporosis in ulcerative colitis: Something new? World J Gastroenterol. 2014;20(39):14087.
26. Zhao X, Zhou C, Chen H, Ma J, Zhu Y, Wang P, et al. Efficacy and safety of medical therapy for low bone mineral density in patients with Crohn disease. Medicine (Baltimore). 2017 Mar;96(11):e6378.
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