Incidence of osteoporosis is significantly increased in patients with inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), compared with the general population, according to the results of a population-based inception cohort study published in the Journal of Crohn’s and Colitis.

To examine the risk for osteoporosis during a long-term period in patients with IBD, researchers from the Copenhagen University Hospital Hvidovre in Denmark used data from a well-defined Copenhagen area population cohort. Information on hospitalizations, diagnoses, and medications was collected from Danish National Registries, and an additional manual search was conducted at local major hospitals to collect data on osteoporosis status. Patients who were diagnosed with CD (n=213) or UC (n=300) between 2003 and 2004 were prospectively included in this study. To generate the control cohort, the investigators included individuals in a 1:20 ratio (n=10,259 control individuals) who were matched to patients with IBD for age, sex, and residency status. All patients were followed until the end of 2015.

A majority (n=352 [69%]) of the patients with IBD received a cumulative dose of ≥500 mg prednisolone or an equivalent amount of corticosteroid within a year (CD: n=167 [78%]; UC: n=185 [62%]; P <.05), which the researchers defined as being at increased risk for low bone density or osteoporosis.

During the study period, 14.2% (n=73) of all patients with IBD (CD: n=31 [14.6%]; UC: n=42 [14.0%]) and 6.6% (n=680) of individuals in the control group (P <.001) were diagnosed with osteoporosis. The investigators reported an increased risk for osteoporosis in the IBD group compared with the control group (CD: odds ratio, 2.9 [95% CI, 2.0-4.1]; UC: odds ratio, 2.8 [95% CI, 2.1-3.9]). Moreover, this trend was more pronounced in older patients: in patients aged ≥50 years, 32.7% with CD (P =.01) and 34.5% with UC (P =.01) developed osteoporosis vs 18.2% of people in the control group.


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Despite the observed increased risk for osteoporosis, the investigators reported that a minority of patients with IBD (24%) underwent screening via dual-energy S-ray absorptiometry.

The study was limited by its retrospective design and possible loss of data in local databases during follow-up. Furthermore, calcium and vitamin D supplements are not prescription medications in Denmark, which precluded the researchers from collecting information on their use.

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On the basis of their results, the investigators concluded that there is an increased risk for osteoporosis in patients with IBD, in part because of high doses of corticosteroids, and asserted that there is a need for greater awareness of this risk among patients and physicians.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures. 

Reference

Lo B, Holm JP, Vester-Andersen MK, Bendtsen F, Vind I, Burisch J. Incidence, risk factors and evaluation of osteoporosis in patients with inflammatory bowel disease – a Danish population-based inception cohort with 10 years of follow-up [published online February 4, 2020]. J Crohns Colitis. doi:10.1093/ecco-jcc/jjaa019