Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn's disease.
BACKGROUND
A high prevalence of osteoporosis has been noted in Crohn's disease, but data about fractures are scarce.


METHODS
The relationship between low bone mineral density and the prevalence of vertebral fractures was studied in 271 patients with ileo-caecal Crohn's disease in a large European/Israeli study. One hundred and eighty-one currently steroid-free patients with active Crohn's disease (98 completely steroid-naive) and 90 steroid-dependent patients with inactive or quiescent Crohn's disease were investigated by dual X-ray absorptiometry scan of the lumbar spine, a standardized posterior/anterior and lateral X-ray of the thoracic and lumbar spine, and an assessment of potential risk factors for osteoporosis.


RESULTS
Thirty-nine asymptomatic fractures were seen in 25 of 179 steroid-free patients (14.0%; 27 wedge, 12 concavity), and 17 fractures were seen in 13 of 89 steroid-dependent patients (14.6%; 14 wedge, three concavity). The prevalence of fractures in steroid-naive patients was 12.4%. The average bone mineral density, expressed as the T-score, of patients with fractures was not significantly different from that of those without fractures (-0.759 vs. -0.837; P=0.73); 55% of patients with fractures had a normal T-score. The bone mineral density was negatively correlated with lifetime steroids, but not with previous bowel resection or current disease activity. The fracture rate was not correlated with the bone mineral density (P=0.73) or lifetime steroid dose (P=0.83); in women, but not in men, the fracture rate was correlated with age (P=0.009).


CONCLUSIONS
The lack of correlation between the prevalence of fractures on the one hand and the bone mineral density and lifetime steroid dose on the other necessitates new hypotheses for the pathogenesis of the former.
Departmen of Gastroenterology, University Hospital Maastricht, The Netherlands. rw.strockbrugger@intmed.unimaas.nl
R W
RW
Stockbrügger
E J
EJ
Schoon
S
S
Bollani
P R
PR
Mills
E
E
Israeli
L
L
Landgraf
D
D
Felsenberg
S
S
Ljunghall
G
G
Nygard
T
T
Persson
H
H
Graffner
G
G
Bianchi Porro
A
A
Ferguson
D015502:Absorptiometry, Photon; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D015519:Bone Density; D003424:Crohn Disease / Q000150:complications* / Q000188:drug therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D013256:Steroids
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids