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P544. Bone mineral density measurement using dual energy X-ray in inflammatory bowel disease patients - Are we screening our patients for osteoporosis?

F.A. Rana1, D. Tate2, M.M. Shaikh3, J. Bowles1, 1Great Western Hospital NHS Foundation Trust, Gastroenterology, Swindon, United Kingdom, 2Royal United Hospital NHS Trust, Gastroenterology, Bath, United Kingdom, 3James Cook University Hospital, Rheumatology, Middlesbrough, United Kingdom

Background

Patients with Inflammatory Bowel Disease (IBD) are at an increased risk of osteoporosis [1]. We conducted a multi-centre clinical study to determine compliance with the British Society of Gastroenterology (BSG) guidelines for osteoporosis in IBD. The BSG guidelines recommend measuring bone mineral density (BMD) with Dual-energy X-ray absorptiometry (DEXA) in all patients under the age of 65 years who are exposed to corticosteroids for more than 3 months [1].

Methods

100 patients from two hospitals in the South West England were included in the study. 50 patients with IBD were randomly selected from the IBD Immunomodulator and Biologics database at Hospital A. The 50 most recent clinic patients with IBD on immunomodulators or biologics were included from Hospital B. Medical records (dating back to 2004) of all these patients were investigated to find evidence of corticosteroid use for greater than 3 months.

Results

Out of the 50 patients selected from Hospital A, 3 were above the cut-off age of 65 years and were therefore excluded. Similarly of the 50 patients selected from Hospital B, 3 were above the cut-off age of 65 years and were also excluded from the analysis. At Hospital A out of the 47 patients included in the analysis, 72% patients (n = 34) were exposed to corticosteroids for more than 3 months. Out of these only 32% patients (n = 11) had DEXA scans whilst 68% patients (n = 23) had not had a DEXA scan.

Out of the 47 patients included in the analysis at Hospital B, 100% (n = 47) patients were exposed to corticosteroids for more than 3 months and out of these only 9% patients (n = 4) had DEXA scans whilst 91% patients (n = 43) had not had a DEXA scan.

Figure: Percentage of patients (on corticosteroids for more than 3 months) offered DEXA scan.

Conclusion

The increased risk of osteoporosis in patients with IBD can be reliably assessed by measuring BMD using a DEXA scan [1]. DEXA scan is a relatively simple, and non-invasive investigation and has good accuracy and precision (measurement error of 5–6%) [2,3]. This study has highlighted suboptimal compliance with BSG guidelines. More concerted efforts are warranted to ensure compliance nationally. Locally we intend to publicise this information in the departments and create a reminder note in clinic rooms to prompt clinicians. We intend to repeat the study in 3 months to ensure change has been implemented.

1. NR Lewis & BB Scott (2007), 1. Guidelines for Osteoporosis in Inflammatory Bowel Disease and Coeliac Disease.

2. Svendsen OL, Hassager C, Skodt V (1995), Impact of soft tissue on in vivo accuracy of bone mineral measurements in the spine, hip and forearm: a human cadaver study. J Bone Miner Res, 868–73, 10.

3. Blake GM, Wahner HW, Fogelman I (1999), The evaluation of osteoporosis: DEXA and ultrasound in clinical practice.