Bone Density Reduction in Patients with Crohn Disease and Associations with Demographic and Disease Variables: Cross-sectional Data from a Population-based Study

Background: The extent of bone density reduction in patients with Crohn disease is still being debated. The aim of this study was to examine bone mineral density (BMD) and factors associated with reduced BMD in a representative population of patients with Crohn disease aged between 20 and 70 years. Methods: BMD (using dual energy X-ray absorptiometry) was measured in spine and hip in 55 patients with Crohn disease recruited from the entire Crohn population (n = 96) in a defined area of southern Norway. Demographic and clinical data were also collected. The patients were compared with 52 ageand gender-matched healthy controls. Potential demographic and disease-related factors associated with BMD reduction were statistically tested with bi- and multivariate analyses. Results: The BMD reduction in patients with Crohn disease was 7.1% (P = 0.02) in spine L1-4, 6.1% (P = 0.08) in femoral neck and 8.4% (P = 0.02) in total hip as compared with the controls. In total hip and femoral neck, age, body weight and gender were independently associated with reduced BMD, but in the spine only body weight. Among the disease-related variables, only ever use of prednisolone was independently associated with reduction in BMD but this only in the femoral neck. Conclusions: The spine and hip BMD reduction of 6%-8% is similar to that found in a comparable population-based study performed in another area in Norway. Among the disease-related variables tested for, only the use of prednisolone was independently associated with BMD reduction. However, the BMD reduction measured in this study indicates that disease-related mechanisms are involved.     

Bone Mineral Density in Hemophilia Patients

Patients with hemophilia suffer from low bone mineral density (BMD) due to several risk factors including arthropathy and resulting immobility. Recent studies have shown variable frequency of low BMD in this group of patients. This study attempts to assess the prevalence of low BMD (osteoporosis and osteopenia) and the associated risk factors in a group of Iranian hemophilia patients. Patients with moderate or severe hemophilia underwent BMD measurement by dual energy X-ray absorptiometry. The results were correlated with other variables including physical activity, calcium intake and demographic data. Forty two patients with the mean age of 31 years (range 18–72) completed the study. The prevalence of osteoporosis in the spine and the left femoral neck was 23.8 and 14.6 %, respectively, and osteopenia in the spine and femoral neck was seen in 45.2 and 31.7 % of the patients, respectively based on the WHO T-score criteria. We found only cigarette smoking to be significantly related to low BMD (P < 0.001). There were two cases of pathologic fracture at femoral neck and forearm (4.8 %). Low BMD is very common in patients with hemophilia. Appropriate assessment of BMD and control of predisposing factors such as prophylactic factor replacement (to prevent hemarthrosis) and cessation of cigarette smoking are warranted.     

Effect of Rocaltrol on Bone Mass in Patients with Pulmonary Disease Treated with Corticosteroids

The aim of this study was to evaluate the effect of calcitriol on bone mass in patients with corticosteroid induced osteoporosis. Thirty-seven patients (26 females, 11 males, mean age 66.4 years) with pulmonary disease under long-term treatment with corticosteroids (5–10 mg prednisolone daily) and osteopenia/osteoporosis verified by dual-energy x-ray absorptiometry (DEXA) measurement were enrolled into the study. Rocaltrol was prescribed to 30/37 of the patients, the rest of the patients (6 females, 1 male) served as controls. In the treatment group, there was a slight increase of bone mass in the hip and lumbar vertebrae (L1–L4), whereas the control group showed a decrease of bone mass (change rate of bone mass in patients +0.8% and +1.0%, respectively, vs. –1.9% and –0.3%, respectively, in the control group). The preliminary results of our study suggest a beneficial role for the treatment of corticosteroid induced osteoporosis with Rocaltrol, which is well-tolerated by patients and cost-efficient in patient management.     

Effect of Rocaltrol on Bone Mass in Patients with Pulmonary Disease Treated with Corticosteroids

The aim of this study was to evaluate the effect of calcitriol on bone mass in patients with corticosteroid induced osteoporosis. Thirty-seven patients (26 females, 11 males, mean age 66.4 years) with pulmonary disease under long-term treatment with corticosteroids (5-10 mg prednisolone daily) and osteopenia/osteoporosis verified by dual-energy x-ray absorptiometry (DEXA) measurement were enrolled into the study. Rocaltrol was prescribed to 30/37 of the patients, the rest of the patients (6 females, 1 male) served as controls. In the treatment group, there was a slight increase of bone mass in the hip and lumbar vertebrae (L1-L4), whereas the control group showed a decrease of bone mass (change rate of bone mass in patients +0.8% and +1.0%, respectively, vs. -1.9% and -0.3%, respectively, in the control group). The preliminary results of our study suggest a beneficial role for the treatment of corticosteroid induced osteoporosis with Rocaltrol, which is well-tolerated by patients and cost-efficient in patient management.     

Assessing Fracture Risk and Effects of Osteoporosis Drugs: Bone Mineral Density and Beyond

Although there have been numerous advances in the assessment of bone strength and fracture risk, the majority of these techniques can only be performed in research laboratories, making them largely unavailable to practicing clinicians. Prospective epidemiologic studies have identified risk factors that can be assessed within the clinic and combined with bone mineral density to allow clinicians to better identify untreated individuals at heightened risk for fracture and to make informed treatment decisions based on 10-year absolute fracture risk. This article discusses the assessment of fracture risk in clinical practice, reviews currently and soon-available bone measurement tools, and details the impacts of osteoporosis therapies on fracture risk.     

Bone remodelling in osteoporosis

Bone remodelling, a highly regulated succession of events, is the temporal sequence of osteoclastic bone resorption and osteoblastic bone formation. Bone loss with age and in osteoporotic patients is due to a desequilibrium between both processus. Bone histomorphometry was the method used to measure these events. Its shows clearly that, with age, the quantity of bone formed in one remodelling unit (so called mean wall thickness) decreases. In osteoporotic women, compared to control women of the same age the amount of bone formed is also decreased. Concordant data on this point have been obtained in different laboratories. By contrast, the cellular mechanism underlying this decreased amount of bone formed is largely controversial: a decreased osteoblast recruitment or life span or capacity to synthetise collagen have been suggested. Bone loss with age is associated with an increase in the amount of bone resorbed. This observation is the result of an indirect measurement founded on the distance between trabeculae. As the decreased bone formation, this processus is exaggerated in postmenopausal osteoporosis. The respective importance of decreased bone formation and increased bone resorption is however difficult to assess. Some osteoporotic patients have increased bone resorption surfaces compared to control women on their bone biopsy; however, it does not seem that these patients form a definite subgroup of osteoporotic patients as the extent of resorption surfaces changes with time in an untreated osteoporotic. In conclusion, the observed changes in bone remodelling in osteoporotic postmenopausal women are an exaggeration of those observed during ageing. These changes should be a basis for a coherent therapy of bone loss in osteoporotic patients.     

Longitudinal Study of Cortical Bone Loss in Patients with Inflammatory Bowel Disease

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18–70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1–8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.     

Metabolic Bone Disease of Prematurity: Report of Four Cases

Osteopenia of prematurity has become a common problem recently because of improved survival rates of infants with very low birth weight (VLBW). The incidence of neonatal osteopenia is inversely correlated with gestational age and birth weight. Herein, we present four cases of preterm osteopenia that were referred to the pediatric endocrinology outpatient clinic with diverse clinical and laboratory findings and we discuss the clinical course of these infants with regard to bone disease after discharge from the neonatal intensive care unit (NICU). This report highlights the importance of enteral calcium, phosphorus and vitamin D support at adequate doses following discharge from NICU for preterm infants with VLBW who are at risk of metabolic bone disease.     

系统性硬皮病妇女骨密度测定的探讨

目的　了解系统性硬皮病 (SSc)绝经前女性患者的骨量变化及糖皮质类固醇激素 (简称激素 )对其骨量变化的影响。方法　应用英国McCueCuBA公司生产的Clinical型定量骨超声测定仪 ,对 5 8例绝经前女性SSc患者 (35例服激素 ,2 3例未服激素 )的左脚跟骨作了宽频超声衰减 (BUA)和超声传导速度 (VOS)测定 ,其中 19例SSc患者在滤泡期同步测定血清雌二醇 (E2 )均与 2 3名正常对照者进行比较分析。结果　SSc患者服激素组BUA和VOS测定值均显著低于SSc患者非激素组(P <0 0 0 1)及正常对照组 (P <0 0 0 1) ,骨质疏松、骨量缺少的发生率显著高于SSc患者非激素组 (P<0 0 0 1)及正常对照组 (P <0 0 0 1)。SSc患者非激素组和正常对照组比较 ,BUA和VOS测定值差异均无显著性 (P >0 0 5 )。结论　绝经前女性SSc患者激素组BUA和VOS均明显下降 ,骨量减少 ;非激素组BUA及VOS和正常人比较差异均无显著性 ,显示SSc并非全身性骨质疏松的危险因子。而SSc患者骨量减少发生率较高和此病不少患者长期服用糖皮质类固醇激素有关。     

Long-Term Effects of Pamidronate in Thalassemic Patients with Severe Bone Mineral Density Deficits

Osteoporosis is a common complication in thalassemia major (TM). Our previous study demonstrated severe bone mineral density (BMD) deficits at spine and hip in 62 and 35% of TM patients. This study assessed the effects of different treatments (calcium, vitamin D and bisphosphonate) on patients' BMD, which was measured at baseline and after 3-year treatments by dual energy X-ray absorptiometry (DEXA). Twenty-one untreated patients, 11 patients on calcium/vitamin D and seven patients on additional pamidronate, were recruited. They were comparable for gender (p = 0.630) and serum ferritin levels (p = 0.412). The median BMD Z-scores at lumbar spine and left hip improved only in patients with standard plus pamidronate treatments (baseline: ?3.01 and ?3.05, end-of-study: ?2.12 and ?2.09; p = 0.018 and 0.028, respectively). In contrast, BMD Z-scores at hip worsened in untreated patients (p = 0.034). In conclusion, long-term improvement in BMD in TM patients was observed with bisphosphonate but not calcium and vitamin D treatment.     

Long-term Fracture Risk in Patients with Celiac Disease: A Population-Based Study in Olmsted County,Minnesota

Celiac disease is associated with decreased bone density, but there are conflicting data regarding fracture risk. We determined the fracture incidence relative to matched controls in a population-based cohort with celiac disease before and after diagnosis. Olmsted County residents with celiac disease (n = 83) diagnosed between 1950 and 2002 were compared with 166 gender and age matched controls. Fracture histories were ascertained from each subject’s medical records. Celiac disease is linked to an increased fracture risk before and after diagnosis. Before the index date, cases had a fracture rate twice that of controls (CI: 1.0–3.9, P = 0.045) and 2.5-fold greater after the index date (CI: 1.1–5.6, P = 0.026). Appendicular and axial fractures were 2.5 (CI: 0.9–6.5) and 3.2 times more likely (CI: 1.0–10.5) after the index date. These observations support a rationale for earlier detection of celiac disease, and active management of bone disease before bone effects have occurred, to reduce the persistent risk of fractures.     

Frequency of Low Bone Mineral Density in Saudi Patients with Inflammatory Bowel Disease

Background/Aims:

Metabolic bone disease is common in patients with inflammatory bowel disease (IBD). Our aim was to determine the frequency of bone loss among Saudi patients with IBD and possible contributing risk factors.

Settings and Design:

We retrospectively reviewed Saudi patients with IBD, between 18 and 70 years of age, who had bone mass density (BMD) determined by dual-energy X-ray absorptiometry scanning at one of three hospitals in the Kingdom of Saudi Arabia from 2001 to 2008.

Patients and Methods:

Case notes and BMDs results were carefully reviewed for demographic and clinical data. Low bone mass, osteopenia, and osteoporosis were defined according to the WHO guidelines.

Statistical Analysis Used:

Predictive factors for BMD were analyzed using group comparisons and stepwise regression analyses.

Results:

Ninety-five patients were included; 46% had Crohn''s disease (CD) and 54% had ulcerative colitis (UC). The average age was 30.9±11.6 years. Using T-scores, the frequency of osteopenia was 44.2%, and the frequency of osteoporosis was 30.5% at both lumbar spine and proximal femur. Only 25.3% of patients exhibited a BMD within the normal range. Our results revealed a positive correlation between the Z-score in both the lumbar spine and the proximal femur and body mass index (BMI) (P=0.042 and P=0.018, respectively). On regression analysis BMI, age, and calcium supplementation were found to be the most important independent predictors of BMD.

Conclusions:

Saudi patients with IBD are at an increased risk of low BMD and the frequency of decreased BMD in Saudi patients with CD and UC were similar. BMI and age were the most important independent predictors of low BMD.