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P543. Combined immunosuppression, corticoids and menopause have significant influence on bone mineral density of IBD patients. A prospective study

A. Krajcovicova, T. Hlavaty, Z. Killinger, E. Miznerova, J. Toth, D. Cierny, T. Koller, J. Letkovsky, Z. Zelinkova, M. Huorka, J. Payer, University Hospital Bratislava, 5th Department of Internal Medicine, Bratislava, Slovakia

Background

There is a high prevalence of osteoporosis and osteopenia among patients with inflammatory bowel diseases (IBD). The effect of recommended vitamin D (VD) and calcium (Ca) supplementation in IBD patients is not precisely known. Furthermore there is lack of clinical data on the impact of corticosteroid (CS) and immunosuppressive therapy (IS) on the bone mineral density (BMD).

Methods

The aim was to analyse the effect of VD/Ca, CS and IS therapy on the BMD of IBD patients. The cohort consisted of 52 IBD patients. In every patient demographic, clinical characteristics and medication were recorded at baseline and on every follow-up visit. Patients with low BMD at baseline were supplemented with 800 IU VD and 1000 mg Ca bid. The BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and total femur at baseline and then every 1–2 years at follow-up. We calculated the average change in BMDL per year and analysed the impact of clinical factors, medication and VD/Ca supplementation. The change of BMDL was compared with least significant change (LSC <0.03) to determine significant improvement or worsening.

Results

The median follow-up was 2.9 years. The average BMDL at baseline was 0.964±0.113 g/cm2. The average BMDL at the last follow-up visit was 0.985±0.133 g/cm2. The average change of BMDL per year was 0.010 g/cm2/year (in average +1.0%). We observed significant improvement in BMDL in 26/52 (50%) of patients, no change in 17/52 (32.7%) and worsening in 9/52 (17.3%).

On multivariate analysis the change of BMDL per year was positively influenced by combined IS and antiTNFa therapy (COMBO) and negatively by CS and menopause. The change of BMDL per year in men was 0.014±0.005 g/cm2/yr, in premenopausal women 0.016±0.006 g/cm2/yr and in postmenopausal women −0.012±0.009 g/cm2/yr; p = 0.01. Among patients with no IS the change of BMDL per year was −0.001±0.010 g/cm2/yr, patients with AZA −0.001±0.013 g/cm2/yr, patients with antiTNF 0.003±0.006 g/cm2/yr and among patients with COMBO 0.027±0.004 g/cm2/yr; p < 0.05 COMBO vs any other subgroup. The change of BMDL per year among patients treated with CS was −0.031±0.012 g/cm2/yr versus CD free patients 0.013±0.004 g/cm2/yr; p < 0.001.

There was no effect of VD/Ca supplementation on BMDL, neither on the serum VD levels.

Conclusion

In our prospective study the bone mineral density of IBD patients was positively influenced by combined immunosuppressive/antiTNF therapy and negatively by corticosteroids and menopause. Vitamin D and calcium supplementation in recommended doses had no effect.