Metabolic bone assessment in patients with inflammatory bowel disease.
OBJECTIVE
Patients with inflammatory bowel disease are at risk for osteopenia. To study the metabolic bone status of these patients, a cross-sectional study was conducted.


METHODS
Eighty-four patients (49 women, 35 men) with inflammatory bowel disease, 34 of whom had Crohn's disease and 50 ulcerative colitis (including 18 with prior coloproctectomy and ileoanal anastomosis), underwent clinical, dietary, and spine radiological assessments. Bone metabolism was assessed by measuring serum levels of calcium, phosphate, parathyroid hormone (1-84), 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, and osteocalcin. Lumbar and femoral neck bone mineral densities were measured by dual energy X-ray absorptiometry.


RESULTS
Serum osteocalcin level was decreased in 29 patients (34%), 12 of whom had never undergone steroid therapy. The other biochemical markers of bone metabolism were in the normal range. Thirty-six patients (43%) had osteopenia, and 6 patients (7%) had vertebral crush fractures. Osteopenia was observed in 27 patients (52%) and 9 patients (28%) with and without corticosteroid therapy, respectively. No patient had clinical or biological signs of osteomalacia. Analysis of bone density (lumbar Z score) by a multiple regression analysis showed a statistically significant correlation with age, cumulative corticosteroid doses, sedimentation rate, and osteocalcin level (R2 = 0.76; P = 0.05).


CONCLUSIONS
The results suggest that bone turnover in inflammatory bowel disease is characterized by low bone formation in the presence of normal levels of calcium-regulating hormones.
Service d'Hepato-gastroentérologie, Hôpital Cochin, Paris, France.
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V
Abitbol
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C
Roux
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Chaussade
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Guillemant
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Kolta
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M
Dougados
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D
Couturier
B
B
Amor
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000453:epidemiology / Q000209:etiology*; D001842:Bone and Bones / Q000378:metabolism*; D002117:Calcitriol / Q000097:blood; D002118:Calcium / Q000097:blood; D003093:Colitis, Ulcerative / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D003424:Crohn Disease / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000097:blood; D011446:Prospective Studies; D012307:Risk Factors
D000305:Adrenal Cortex Hormones; D015675:Osteocalcin; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002118:Calcium