Metabolic bone disease is present at diagnosis in patients with inflammatory bowel disease.
OBJECTIVE
To establish whether bone disease is present at diagnosis in inflammatory bowel disease and to identify contributory metabolic abnormalities.


METHODS
Newly diagnosed patients with inflammatory bowel disease (19 males, 15 females; mean age, 44 years; range, 17-79 years; 23 ulcerative colitis, 11 Crohn's disease) were compared against standard reference ranges and a control group with irritable bowel syndrome (eight males, 10 females; mean age, 40 years; range, 19-64 years). Bone mineral density (g/cm2, dual-energy X-ray absorptiometry: lumbar spine and femoral neck) and biochemical bone markers were measured.


RESULTS
Femoral neck bone mineral density, T- and Z-scores (mean +/- s.d., respectively) were lower in inflammatory bowel disease patients than in irritable bowel syndrome controls (0.78 +/- 0.12 vs. 0.90 +/- 0.16, P = 0.0046; - 0.88 +/- 0.92 vs. 0.12 +/- 1.17, P = 0.0018; - 0.30 +/- 0.89 vs. 0.61 +/- 1.10, P = 0.0030). Lumbar spine bone mineral density and T-scores were also significantly lower in patients than controls (0.98 +/- 0.15 vs. 1.08 +/- 0.13, P = 0.0342; - 1.05 +/- 1.39 vs. - 0.14 +/- 1.19, P = 0.0304). Compared with controls, the urinary deoxypyridinoline : creatinine ratio was increased (7.66 vs. 5.70 nmol/mmol, P = 0.0163) and serum 25-hydroxy vitamin D was decreased (18.7 vs. 28.5 micro g/L, P = 0.0016); plasma osteocalcin and serum parathyroid hormone did not differ (P > 0.05).


CONCLUSIONS
The bone mineral density is reduced at diagnosis, prior to corticosteroid treatment, in both Crohn's disease and ulcerative colitis. Our data suggest that this is attributable to increased resorption rather than decreased bone formation.
Lamb
E J
EJ
Department of Clinical Biochemistry, East Kent Hospitals NHS Trust, Kent, UK. edmund.lamb@ekht.nhs.uk
Wong
T
T
Smith
D J
DJ
Simpson
D E
DE
Coakley
A J
AJ
Moniz
C
C
Muller
A F
AF
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000503:physiopathology; D003109:Colonic Diseases, Functional / Q000150:complications / Q000503:physiopathology; D003424:Crohn Disease / Q000150:complications / Q000503:physiopathology; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
D015415:Biomarkers