title: Combination therapy with an immunomodulator and anti-TNFα agent improves bone mineral density in IBD patients.
abstract: OBJECTIVE
  There is a high prevalence of low bone mineral density (BMD) among patients with inflammatory bowel disease (IBD) although there is a lack of clinical data on the impact of IBD specific medications and recommended vitamin D (VD) and calcium (Ca) supplements on it.
  
  
  METHODS
  The cohort consisted of 150 IBD patients. The average change in BMD at the lumbar spine per year (∆BMDL/year) was calculated and the impact of clinical characteristics, medications and VD and Ca supplements was analysed.
  
  
  RESULTS
  The prevalence of osteopenia was 69/150 (46%) and osteoporosis was identified in 15/150 (10%) patients at baseline. The presence of osteoporosis was associated with the disease duration OR=1.07 per year of disease duration (95% CI=1.01-1.14), p=0.03. The average ∆BMDL/year was 0.010 g/cm(2)/year. Among patients with no IS the ∆BMDL/year was -0.001±0.010 g/cm(2)/year, with AZA -0.001±0.013 g/cm(2)/year, with anti-TNFα 0.003±0.006 g/cm(2)/year and with COMBO 0.027±0.004 g/cm(2)/year; p<0.05 COMBO vs any other subgroup. ∆BMDL/year among patients treated with CS was -0.031±0.012 g/cm(2)/year versus CS free patients 0.013±0.004 g/cm(2)/year; p<0.001. There was no effect of VD/Ca supplementation on BMDL.
  
  
  CONCLUSIONS
  The prevalence of low BMD was 55%. Duration of disease was the only independent predictor of low BMD. The BMDL was reduced by high cumulative dose of CS and improved by combined anti-TNFα/AZA therapy. The supplementation with recommended doses of VD and Ca had no effect on BMDL.
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia. Electronic address: krajann@hotmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Krajcovicova
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Tibor
authors.initials: T
authors.lastname: Hlavaty
authors.affiliation: Osteocenter, University Hospital Bratislava, Slovakia.
authors.forename: Zdenko
authors.initials: Z
authors.lastname: Killinger
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Ema
authors.initials: E
authors.lastname: Miznerova
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Jozef
authors.initials: J
authors.lastname: Toth
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Juraj
authors.initials: J
authors.lastname: Letkovsky
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Monika
authors.initials: M
authors.lastname: Nevidanska
authors.affiliation: Osteocenter, University Hospital Bratislava, Slovakia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cierny
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Koller
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Zelinkova
authors.affiliation: Gastroenterology and Hepatology Unit, University Hospital Bratislava, Slovakia.
authors.forename: Martin
authors.initials: M
authors.lastname: Huorka
authors.affiliation: Osteocenter, University Hospital Bratislava, Slovakia.
authors.forename: Juraj
authors.initials: J
authors.lastname: Payer
mesh_terms: D015502:Absorptiometry, Photon; D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000008:administration & dosage; D001851:Bone Diseases, Metabolic / Q000209:etiology / Q000517:prevention & control*; D002136:Calcium, Dietary / Q000008:administration & dosage; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy*; D000069285:Infliximab; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014807:Vitamin D / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D002136:Calcium, Dietary; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D014807:Vitamin D; D019804:Mesalamine; D000069285:Infliximab; D000068879:Adalimumab; D001379:Azathioprine
keywords: Crohn's disease; Immunosuppressive therapy; Osteoporosis; Ulcerative colitis