Osteoporosis in Inflammatory Bowel Diseases

Öz

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

Öz

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. 

Anahtar Kelimeler

• İnflamatuvar barsak hastalığı,metabolik kemik hastalığı,osteoporoz,osteopeni

Kaynakça

1. 1. Ott C, Schölmerich J. Extraintestinal manifestations ve complications in IBD. Nat Rev Gastroenterol Hepatol. 2013; 10: 585-95
2. 2. Miheller P, Gesztes W, Lakatos PL. Manipulating bone disease in inflammatory bowel disease patients. Ann Gastroenterol. 2013; 26: 296-303
3. 3. Rothfuss KS, Stange EF, Herlinger KR. Extraintestinal manifestations and complications in inflammatory bowel disease. World J Gastroenterol. 2006; 12: 4819-31
4. 4. Ali T, Lam D, Bronze MS, Humphrey MB. Osteoporosis in inflammatory bowel disease. Am J Med. 2009; 122: 599-604
5. 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. 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. 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. 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. 9. Braun T, Schett G. Pathways for bone loss in inflammatory bowel disease. Curr Osteoporos Rep. 2012; 10: 101-8
10. 10. Compston J. Osteoporosis in inflammatory bowel disease. Gut. 2003; 52(1): 63-4
11. 11. Targownik LE, Bernstein CN, Leslie WD. Inflammatory bowel disease and the risk of osteoporosis and fracture. Maturitas. 2013; 76: 315-9
12. 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. 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. 14. Leftus EV, Sandborn VJ. Epidemiology of inflammatory bowel disease. Gastroenterol Clin N Am. 2012; 31(1): 1-20
15. 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. 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. 17. Von Tirpitz C, Reinshagen M. Management of osteoporosis in patients with gastrointestinal disease. Eu J Gastroenterol Hepatol. 2003; 15: 869-76
18. 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. 19. Özdemir ZT, Acar A, Karabulut L. İnflamatuar barsak hastalığında osteoporoz ve vertebra kırıkları. Bozok Tıp Derg. 2014; 4(1): 48-54
20. 20. Bernstein CN, Leslie WD, Leboff MS. AGA technical review on osteoporosis in gastrointestinal diseases. Gastroenterology. 2003; 124: 795-841
21. 21. Van Hogezand RA, Hamdy NA. Skeletal morbidity in inflammatory disease. Scand J Gastroenterol Suppl. 2006; 243: 59-64
22. 22. Tezel A, Can G. İnflamatuvar barsak hastalıkları ve osteoporoz. Güncel Gastroenteroloji. 2013; 17(4): 363-9
23. 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