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P507. Evolution of osteopenia and osteoporosis over 5 years in patients with inflammatory bowel disease

F. Casals-Seoane1, M. Chaparro1, M.-R. González-Casas1, J. Maté-Jiménez1, J.P. Gisbert1, 1Hospital Universitario de La Princesa, IP, Gastroenterology and CIBEREHD, Madrid, Spain

Background

Osteopenia and osteoporosis are frequent in patients with inflammatory bowel disease (IBD). However, most of the studies include small cohorts with short follow-up times.

Aims: (1) To study the evolution of metabolic bone disorders in IBD patients after 5 years of follow up. (2) To assess the effect of treatment with calcium and vitamin D and bisphosphonates for the prevention and improvement of abnormal bone density (osteopenia and osteoporosis) in patients with IBD. (3) To identify factors that influence in the densitometry values of patients with IBD.

Methods

Prospective study with 5 years of follow up including IBD patients. At baseline, a complete blood and urine test and a lumbar and hip densitometry was performed. Following clinical guidelines, calcium and vitamin D were administered to patients with osteopenia, and biphosphonates were given to patients with osteoporosis. After five years of clinical follow up, the tests were repeated. Data from flares, hospitalizations, surgeries and treatments during follow-up was collected.

Results

58 patients with IBD were included (52% with Crohn's disease). At baseline, the proportion of patients with abnormal bone density was 64% (43% osteopenia and 21% osteoporosis). Osteopenia was much more common in CD patients than in those with UC (63% vs 21%, p < 0.05). A decrease of the prevalence of osteoporosis was observed at the end of the follow-up period (21% vs. 10.3%, p < 0.05), while the percentage of osteopenia was higher (43% vs. 50%, p > 0.05). Our results also showed an increasing t-score over time: mean hip t-score values increased from −0.734 to −0.384 (p < 0.001) while lumbar t-score values remained more stable (−1.17 vs −1.15, p > 0.05). Linear regression analysis showed that in patients with hip and lumbar osteopenia, treatment with calcium and vitamin D was statistically associated with an improvement of the densitometry values (p < 0.005), while in patients with osteoporosis treatment with biphosphonates increased mean t-score (p < 0.005). The different IBD treatments, nutritional status, number of flares or smoking showed no statistically significant associations with the changing values of bone densitometry.

Conclusion

Osteopenia and osteoporosis are very frequent in IBD patients. Treatment with calcium and vitamin D in patients with osteopenia improves their densitometry scores. Treatment with biphosphonates in patients with osteoporis is associated with an improvement of their abnormal bone density.