Low body mass index can identify majority of osteoporotic inflammatory bowel disease patients missed by current guidelines.
BACKGROUND
Patients with inflammatory bowel disease (IBD) are at high risk of developing osteoporosis. Our objective was to determine the usefulness of IBD guidelines in identifying patients at risk for developing osteoporosis.


METHODS
We utilized institutional repository to identify patients seen in IBD center and extracted data on demographics, disease history, conventional, and nonconventional risk factors for osteoporosis and Dual Energy X-ray Absorptiometry (DXA) findings.


RESULTS
59% of patients (1004/1703) in our IBD cohort had at least one risk factor for osteoporosis screening. DXA was documented in 263 patients with indication of screening (provider adherence, 26.2%), and of these, 196 patients had DXA completed ("at-risk" group). Ninety-five patients not meeting guidelines-based risk factors also had DXA completed ("not at-risk" group). 139 (70.9%) patients in "at-risk" group had low BMD, while 51 (53.7%) of "not-at-risk" patients had low BMD. Majority of the patients with osteoporosis (83.3%) missed by the current guidelines had low BMI. Multivariate logistic regression analysis showed that low BMI was the strongest risk factor for osteoporosis (OR 3.07; 95% CI, 1.47-6.42; P = 0.003).


CONCLUSIONS
Provider adherence to current guidelines is suboptimal. Low BMI can identify majority of the patients with osteoporosis that are missed by current guidelines.
Department of Gastroenterology, A-31, Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. atrejaa@ccf.org
Ashish
A
Atreja
Ashish
A
Aggarwal
Angelo A
AA
Licata
Bret A
BA
Lashner
D015502:Absorptiometry, Photon / Q000379:methods; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control; D017408:Guidelines as Topic; D006801:Humans; D007249:Inflammation; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis*; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors