title: Increased fracture risk and osteoporosis not associated with vitamin D levels in Malaysian patients with inflammatory bowel disease.
abstract: BACKGROUND
  Osteoporosis and osteopenia are well-recognized complications of inflammatory bowel disease. Previous studies have suggested that vitamin D deficiency is an important risk factor for the development of osteoporosis. We hypothesized that low vitamin D levels is the main reason for reduced bone mineral density in patients with inflammatory bowel disease. We aimed to study its potential role in Malaysia, which is a tropical country with 3 large ethnic groups. We also sought to examine the relationship between fracture risk and bone mineral density in this group.
  
  
  METHODS
  Relevant history as well as 25-hydroxycholecalciferol (vitamin D) levels and bone mineral density were obtained. Normal, inadequate, and low vitamin D levels were defined as 61-160 nmol/L (24-64 ng/mL), 30-60 nmol/L (12-24 ng/mL), and less than 30 nmol/L (<12 ng/mL), respectively.
  
  
  RESULTS
  Seventy-two patients were recruited. The prevalence of osteopenia and osteoporosis, respectively, were 58% and 17% in the spine and 51% and 14% in the hip. Mean vitamin D level in the group was low at 45.12 ± 17.4 nmol/L (18.05 ± 6.96 ng/mL), but there was no significant association between bone mineral density and vitamin D level. Twelve patients (16.7%) had a fragility fracture after the diagnosis of inflammatory bowel disease. The cumulative fracture incidence was 10% at 5 years and 35% at 10 years. There was a statistically significant association between osteoporosis of hip and a history of fracture (odds ratio 5.889; 95% confidence interval 1.41-24.53, P = .009).
  
  
  CONCLUSIONS
  Osteoporosis is prevalent among Malaysian patients with inflammatory bowel disease and is associated with a 6-fold increased risk of fractures. Most inflammatory bowel disease patients had inadequate or low vitamin D levels, but there was no association between vitamin D levels and BMD.
authors.affiliation: Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ida
authors.initials: I
authors.lastname: Hilmi
authors.forename: K
authors.initials: K
authors.lastname: Sunderesvaran
authors.forename: Vijay
authors.initials: V
authors.lastname: Ananda
authors.forename: S A
authors.initials: SA
authors.lastname: Sarji
authors.forename: Kulenthran
authors.initials: K
authors.lastname: Arumugam
authors.forename: K L
authors.initials: KL
authors.lastname: Goh
mesh_terms: D000328:Adult; D000368:Aged; D015519:Bone Density; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D008296:Malaysia; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012306:Risk; D014807:Vitamin D / Q000097:blood*
chemical_list: D014807:Vitamin D