The Relationship Between Inflammatory Bowel Disease and Bone Mineral Density. Results of a Population-based Study

Purpose: Patients with inflammatory bowel disease (IBD) are at higher risk of osteoporosis and related fractures. Most studies on IBD and BMD are from selected referral centres and do not delineate what aspects of IBD contribute to lower BMD. Methods: We created a linkage between the University of Manitoba IBD Epidemiologic Database and the Manitoba BMD Database, which respectively capture virtually all persons in Manitoba, Canada with diagnosed IBD and all persons with clinical DXA measurements, respectively. BMD was assessed at each of the lumbar spine (L1-L4), total hip, femoral neck and greater trochanter. Multivariate linear and logistic regression were performed to determine the independent effect of an IBD diagnosis on T-scores and on the likelihood of having an osteoporotic T-score (-2.5 or lower) at each of the four BMD sites. We developed both a partially adjusted model (for age, sex, and body mass index [BMI]) and fully adjusted model (additionally adjusted for hormone replacement therapy [HRT], osteoprotective therapy [OTX], and recent systemic glucocorticoid [GC] use). Results: 45,714 patients age 20 and older underwent baseline BMD testing between 1997 and 2008, 1,230 of whom had IBD. Compared with non-IBD subjects, subjects with IBD were more likely to be younger, male, and have lower BMI. IBD patients were significantly more likely to be recent GC users (26% vs 6%). When adjusted for age, sex and BMI, IBD was associated with lower T-scores at each of the four assessment sites (Table 1). IBD was also associated with having an osteoporotic T-score at the L1-L4 and the total hip (Table 1). However, when the model was further adjusted for exposure to GCs, HRT, and OTX, IBD was associated with only a marginal reduction in T-scores at the total and the greater trochanter. Moreover, IBD was not associated with a higher risk of having an osteoporotic T-score at any of the four sites in the fully adjusted model. Conclusion: While patients with IBD are at higher risk for lower BMD and for osteoporosis, this effect is not seen after adjusting for exposure to GCs and other medications. This suggests that the deleterious effects of IBD on BMD are predominantly related to GCs rather than to the IBD itself. Further work is required to delineate the independent effects of IBD, inflammatory activity, and its therapies on BMD and fracture risk.

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