Osteoporosis in Inflammatory Bowel Diseases

Year 2019, Volume: 41 Issue: 4, 380 - 387, 01.10.2019

Erdal Dilekçi Ahmet Tezel Güray Can Muhammed Emin Demirkol Esra Nur Ademoğlu Dilekçi Müjgan Gürler Edip Erkuş Gülbin Ünsal Ali Rıza Soylu Hasan Celalettin Ümit Meral Akdoğan Kayhan Mehmet Kayhan Çağlar Keskin

https://doi.org/10.20515/otd.441291

Abstract

Inflammatory
bowel disease is a group of systemic chronic inflammatory disease that
predominantly affects the gastrointestinal tract. Extraintestinal findings are
frequently together in inflammatory bowel disease. Of these, metabolic bone
diseases are considerably frequent. In our study, we aimed to reveal the
frequency of osteoporosis and osteopenia in our own inflammatory bowel disease cohort.
In this study, 71 ulcerative colitis and 44 bone mineral density data of
Crohn's patients were retrospectively evaluated. Bone densities, T and Z scores
were compared according to involvement pattern, diagnosis, disease behavior,
gender and bone mineral density localizations in inflammatory bowel disease . Osteopenia
and osteoporosis were detected in 53,5% and 22,5% of ulcerative colitis
patients and in 50% and 25% of Crohn's patients respectively. There was no significant
difference between ulcerative colitis and Crohn's patients. In Crohn's patients,
osteopenia was most frequently detected in the femur neck by 47,7% and in the
wards triangle by 47,7%, in the ulcerative colitis, osteopenia was most
frequently detected in the wards triangle (52,1%). In the ulcerative colitis
and Crohn's patients, osteoporosis was most frequently detected in lumbar
region ( respectively 15,5% and 18,2%). There was no significant difference
between ulcerative colitis and Crohn's patients in terms of osteopenia and osteoporosis.
There was no significant difference in ulcerative colitis and Crohn's patients when
compared in terms of subtype, behavior, gender and localization of bone mineral
density. The frequencies of osteoporosis and osteopenia increase in inflammatory
bowel disease. Larger sample sizes and well-designed prospective studies are
needed to confirm our findings.

İnflamatuvar Barsak Hastalıklarında Osteoporoz Sıklığı

Abstract

İnflamatuvar barsak hastalıkları,
ağırlıklı olarak gastrointestinal sistemi tutan sistemik kronik inflamatuvar
bir hastalık grubudur. İnflamatuvar barsak hastalıklarında ekstraintestinal
bulgular sıklıkla birlikte bulunmaktadır. Bunlar içinde metabolik kemik
hastalıkları azımsanmayacak ölçüde sıktır. Çalışmamızda kendi inflamatuvar
barsak hastalıkları kohortumuzda osteoporoz ve osteopeni sıklığını ortaya
koymayı amaçladık. Bu
çalışmaya 71 ülseratif kolit, 44 Crohn hastasının kemik mineral dansite
verileri retrospektif olarak değerlendirildi. İnflamatuvar barsak hastalığında tanı,
tutulum paterni, hastalık davranışı, cinsiyet ve kemik mineral dansite
lokalizasyonlarına göre kemik dansiteleri, T ve Z skorları karşılaştırıldı. Ülseratif kolit hastalarının
%53,5’inde, Crohn hastalarının %50’sinde osteopeni saptandı. Ülseratif kolit
ile Crohn hastalığı arasında anlamlı fark yoktu. Ülseratif kolit hastalarının
%22,5’inde, Crohn hastalarının %25’inde osteoporoz saptandı. Ülseratif kolit
ile Crohn hastalığı arasında anlamlı fark yoktu. Crohn hastalığında osteopeni
en sık femur boynu ve wards üçgeninde (%47,7 ve %47,7), ülseratif kolit
hastalarında osteopeni en sık wards üçgeninde (%52,1) saptandı. Ülseratif kolit
ve Crohn hastalığında osteoporoz en sık lomber bölgede (sırasıyla %15,5 ve
%18,2) tespit edildi. Ülseratif kolit ve Crohn hastalığı arasında osteoporoz ve
osteopeni açısından anlamlı fark izlenmedi. Ülseratif kolit ve Crohn
hastalığında alttip, davranış, cinsiyet ve kemik mineral dansite lokalizasyon
açısından karşılaştırıldığında anlamlı fark saptanmadı. İnflamatuvar barsak hastalığında osteoporoz
ve osteopeni sıklığı artmıştır. Bulgularımızı doğrulamak için daha büyük
örneklem büyüklüğüyle ve iyi dizayn edilmiş prospektif çalışmalara ihtiyaç
vardır. 

Keywords

İnflamatuvar barsak hastalığı, metabolik kemik hastalığı, osteoporoz, osteopeni

References

• 1. Ott C, Schölmerich J. Extraintestinal manifestations ve complications in IBD. Nat Rev Gastroenterol Hepatol. 2013; 10: 585-95
• 2. Miheller P, Gesztes W, Lakatos PL. Manipulating bone disease in inflammatory bowel disease patients. Ann Gastroenterol. 2013; 26: 296-303
• 3. Rothfuss KS, Stange EF, Herlinger KR. Extraintestinal manifestations and complications in inflammatory bowel disease. World J Gastroenterol. 2006; 12: 4819-31
• 4. Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009; 122: 599-604
• 5. No authors listed. Assesment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tecn Rep Ser. 1994; 843: 1-129
• 6. Van Assche G, Dignass A, Bokemeyer, Danese S, Gionchetti P, Moser G, et al. European Crohn's and Colitis Organisation. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis. Part 3: Special situations. J Crohns colitis. 2013; 7: 1-33
• 7. Moschen AR, Kaser A, Stadlmann S, Millonig G, Kaser S, Mühllechner P, et al. The RANKL/OPG system and bone mineral density in patients with chronic liver disease. J Hepatol. 2005; 43: 973-83
• 8. Ashcroft AJ, Cruickshank SM, Croucher PI, Perry MJ, Rollinson S, Lippitt JM, et al. Colonic dendritic cells, intestinal inflammation and T cell-mediated bone destruction are modulated by recombinant osteoprotogerin. Immunity. 2003; 19: 849-61
• 9. Braun T, Schett G. Pathways for bone loss in inflammatory bowel disease. Curr Osteoporos Rep. 2012; 10: 101-8
• 10. Compston J. Osteoporosis in inflammatory bowel disease. Gut. 2003; 52(1): 63-4
• 11. Targownik LE, Bernstein CN, Leslie WD. Inflammatory bowel disease and the risk of osteoporosis and fracture. Maturitas. 2013; 76: 315-9
• 12. Miheller P, Lorinczy K, Lakatos PL. Clinical relevance of changes in bone metabolism in inflammatory bowel disease. World J Gastroenterol. 2010; 16: 5536-42
• 13. Bernstein CN, Blanchard JF, Leslie W, Wajda A, Yu BN. The incidence of fracture among patients with inflammatory bowel disease. A population-based cohort study. Ann Intern Med. 2000; 133: 795-9
• 14. Leftus EV, Sandborn VJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin N Am. 2012; 31(1): 1-20
• 15. Schoon EJ, Van Nunen AB, Wounter RS, Stockbrügger RW, Russel MG, et al. Osteopenia osteoporosis in in Crohn's disease: Prevalance in a Dutch population-based cohort. Scand J Gastroenterol. 2000; 232: 43-7
• 16. Frei P, Fried M, Hugenbühler V. Analysis of risk factors for low bone mineral density in inflammatory bowel disease. Digestion. 2006; 73: 40-6
• 17. Von Tirpitz C, Reinshagen M. Management of osteoporosis in patients with gastrointestinal disease. Eu J Gastroenterol Hepatol. 2003; 15: 869-76
• 18. Jahnsen J, Falch JA, Aadland E, Mowinckel P. Bone mineral density is reduced in patients with Crohn's disease but not in patients with ulcerative colitis: a population based study. Gut. 1997; 40(1): 313-9
• 19. Özdemir ZT, Acar A, Karabulut L. İnflamatuar barsak hastalığında osteoporoz ve vertebra kırıkları. Bozok Tıp Derg. 2014; 4(1): 48-54
• 20. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003; 124: 795-841
• 21. Van Hogezand RA, Hamdy NA. Skeletal morbidity in inflammatory disease. Scand J Gastroenterol Suppl. 2006; 243: 59-64
• 22. Tezel A, Can G. İnflamatuvar barsak hastalıkları ve osteoporoz. Güncel Gastroenteroloji. 2013; 17(4): 363-9
• 23. Targownik LE, Bernstein CN, Nugent Z, Leslie WD. Inflammatory bowel disease has a small effect on bone mineral density and risk for osteoporosis. Clin Gastroenterol Hepatol. 2013; 11(3): 278-85