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P296. Evolution of the bone mineral density in patients with inflammatory bowel disease: A five year follow-up study

J.P. Gisbert1, M. Chaparro1, R. González2, J. Maté1

1Hospital de la Princesa, Madrid, Spain; 2Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain

Introduction: The treatment with steroids, the malnutrition and the inflammatory status are risk factors for having low bone mineral density in patients with inflammatory bowel disease (IBD). Calcium and vitamin D supplements with or without biphosphonates are recommended in patients with osteoporosis or with osteopenia, respectively.

Objective: To assess the long-term evolution of bone mineral density in IBD patients. To evaluate the impact of the administration of calcium and vitamin D supplements and biphosphonates in the prevention and treatment of osteopenia and osteoporosis. To identify factors associated with a higher risk of low bone mineral density in IBD patients.

Methods: IBD patients with a baseline evaluation of the bone mineral density with the dual energy x-ray absorption (DEXA) methodology were prospectively included in a five-year follow-up study. Bone mineral density values for normal bone density, osteopenia and osteoporosis established by the World Health Organization were considered as reference values. Patients with osteopenia at baseline were treated with calcium (1,000–1,500 mg/day) and vitamin D (800 UI/day) supplements. Patients with osteoporosis at baseline were treated with biphosphonates in addition to calcium and vitamin D supplements. Demographic characteristics, medical treatments, surgical interventions, and IBD flares during the follow-up period were recorded. A multivariate analysis was performed to identify predictive factors of having low bone mineral density.

Results: Thirty-six patients were included. Fifty-eight percent were female and 61% had Crohn's disease. According to the results of the baseline DEXA test, 24 patients (67%) had osteopenia and 10 (28%) had osteoporosis. After five years of follow-up, 24 patients (55%) had osteopenia and 6 (17%) had osteoporosis. The two patients with normal values in the baseline DEXA test had osteopenia at the end of the follow-up. Both of them had had two relapses during the follow-up period, but only one of them had been on steroids. From patients with osteopenia at baseline, 70% (17/24) had osteopenia at the end of the follow-up, 4% (1/24) had osteoporosis despite treatment with calcium and vitamin D supplements, and 26% (6/24) had normal values in the DEXA test. Fifty percent of patients (5/10) with osteoporosis in the baseline DEXA test had normal values at the end of the follow-up period, and the other 50% (5/10) still had osteoporosis despite treatment with calcium/vitamin D and biphosphonates.

Conclusions: Alterations of bone mineral metabolism are very common in IBD patients, so the screening would be justified in this population. The administration of the recommended treatment (calcium and vitamin D with or without biphosphonates, depending on the values assessed by DEXA test) seems to improve the bone mineral density in the long-term in IBD patients.