Inflammatory bowel disease and the risk of fracture.
OBJECTIVE
Although patients with inflammatory bowel disease (IBD) have reduced bone mass, there is controversy whether there is an increased risk of fracture. This study examines the risk of fracture and its predictors in patients with IBD.


METHODS
In a primary care- based nested case-control study, 231,778 fracture cases and 231,778 age- and sex-matched controls were recruited. A history of IBD was assessed from medical records.


RESULTS
The prevalence of IBD was 156 and 282 per 100,000 for Crohn's disease (CD) and ulcerative colitis (UC), respectively. Patients with IBD had an increased risk of vertebral fracture (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.61) and hip fracture (OR, 1.59; 95% CI, 1.14-2.23). The risk of hip fracture was greater in patients with CD (OR, 1.86; 95% CI, 1.08-3.21) compared with UC (OR, 1.40; 95% CI, 0.92-2.13). Disease severity, assessed by the number of symptoms, predicted fracture even after adjusting for corticosteroid use (OR, 1.46; 95% CI, 1.04-2.04). Only 13% of patients with IBD who had already sustained a fracture were on any form of antifracture treatment.


CONCLUSIONS
Patients with IBD have a higher risk of fracture due to both disease activity and use of oral corticosteroids. However, few of these patients are receiving optimal bone-sparing therapy, highlighting the importance of increasing awareness of osteoporosis in those managing these patients.
van Staa
Tjeerd-Pieter
TP
Department of Pharmacoepidemiology and Pharmacotherapy, Universtiy of Utrecht, The Netherlands.
Cooper
Cyrus
C
Brusse
Listy Samuels
LS
Leufkens
Hubert
H
Javaid
Muhammad K
MK
Arden
Nigel K
NK
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D012306:Risk
D000305:Adrenal Cortex Hormones