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10-23-2010, 05:27 PM   #1
David in Seattle
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Inflammatory Bowel Disease Associated With Bone Loss, Vitamin D Deficiency

October 22, 2010 (San Antonio, Texas) Patients with inflammatory bowel disease (IBD) who are vitamin D deficient have a significantly increased risk for osteoporosis, osteopenia, and abnormal bone density levels, irrespective of other factors that could place them at a higher risk, according to research presented here at the American College of Gastroenterology (ACG) 2010 Annual Scientific Meeting and Postgraduate Course.

The study of 161 patients diagnosed with IBDs, such as ulcerative colitis and Crohn's disease, found that 22% of patients had a reduction in bone density, and a diagnosis of osteopenia or osteoporosis. Of those with a bone density reduction, 50% were younger than 40 years.

"Bone loss is generally uncommon below the age of 40 in the normal population, so I was a little surprised to see a high number of my patients below that age with abnormal bone density. I do believe that it is further evidence of the effects of IBD," said Bincy P. Abraham, MD, MS, lead author of the study.

Of patients with abnormal dual-energy x-ray absorptiometry (DXA) bone density exams, 40% had higher rates of vitamin D deficiency, defined as levels of 25-hydroxyvitamin D below 30 ng/mL, compared with 1% of those with normal scans (odds ratio [OR], 8.7; 95% confidence interval [CI], 2.4 - 19.8, P = .001).

The higher levels of vitamin D deficiency remained after patients were controlled for corticosteroid intake, age, and sex.

"If you were vitamin D deficient, you were nearly 9 times more likely to have abnormal bone deficiency" than if you weren't, said Dr. Abraham, who is assistant professor of medicine in the Inflammatory Bowel Disease Program at Baylor College of Medicine in Houston, Texas.

"We looked at the other risk factors and still found that vitamin D was the major factor contributing to the abnormal bone density," she said.

Previous studies have reported on the high prevalence of osteoporosis among patients with IBD, with the use of corticosteroid and excess of inflammatory cytokines potentially interfering with bone repair and remodeling. Vitamin D deficiencies have also been reported in such patients, but studies have disagreed about the association between the deficiency and bone density.

The prospective study evaluated patients between the ages of 10 and 70 years who were diagnosed with IBD on the basis of clinical, radiologic, endoscopic, and histologic data.

The results showed that patients with Crohn's disease were much more likely to have abnormal bone density exams than those with ulcerative colitis (34% vs 13%; OR, 4.2; 95% CI, 1.8 - 11.7; P = .02). Those with osteoporosis plus Crohn's disease or ulcerative colitis had significantly higher rates of vitamin D deficiency, regardless of prednisone intake.

The findings suggest that clinicians treating IBD patients need to consider the possibility of low vitamin D levels and be aware of the potential for bone loss among those patients," Dr. Abraham said.

"The first step for clinicians treating IBD patients is to check their vitamin D levels, and if they find a deficiency, treat it," she said.

"I prescribe 50,000 units of vitamin D weekly for 8 weeks and then recheck their levels. I'm usually able to get my patients back to good levels (between 30 to 50 ng/mL). . . . I then wait a year and recheck their DXA scans."

IBD patients are known to be at increased risk for low bone density; however, the study's findings are notable for showing a relation between vitamin D deficiencies and bone loss, said Jean Paul Achkar, MD, a gastroenterologist from the Cleveland Clinic, in Ohio.

"The ACG has guidelines regarding the need to monitor bone density in IBD patients," he said. "It is also increasingly recognized that vitamin D levels need to be monitored and repleted if low in patients with IBD."

"The interesting point of this abstract is the demonstration of a strong association between low vitamin D and abnormal DXA scan, and the fact that this association remained after adjustment for steroid intake and age."

"The study highlights the importance of checking vitamin D levels in addition to routine DXA monitoring."

The study did not receive funding. Dr. Abraham reports being on the speaker's bureau for UCB, Abbott, Warner-Chilcott, Salix, and Prometheus, and the advisory committee for UCB. Dr. Achkar has disclosed no relevant financial relationships.

American College of Gastroenterology (ACG) 2010 Annual Scientific Meeting and Postgraduate Course: Poster P290. Presented October 17, 2010.
10-23-2010, 05:46 PM   #2
xoxava
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Interesting info. My doc has put me on pills bc my vitamin d being low so very interesting to read this. My mom was also diagnosed with osteoporosis so I guess my chance is higher. Thanks for sharing!
10-23-2010, 08:53 PM   #3
effdee
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Thanks for posting this. None of my doctors ever said the words vitamin D so I'll definitely be asking next time.
10-23-2010, 10:15 PM   #4
Sue-2009
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I take 2000mg of Vitamin D...How much does everyone else take? Sue
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10-24-2010, 01:44 AM   #5
Zalanicht
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I take 4000iu every day. Probably a overkill but whatever.
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calcium + vit d. Enjoying my surgery induced remission!
10-24-2010, 03:16 AM   #6
David in Seattle
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Glad people have found this of interest

I also take 4,000 units/day. Especially with the low light levels here in Seattle beginning this time of year, I think it's a good practice.
10-24-2010, 04:06 AM   #7
StarGirrrrl
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It is interesting. I don't know if the body stores up Vitamin D or discards it, but with a load of blood tests earlier in the year my Vitamin D came back slightly lower than the test sample apparently. I take a daily multi vitamin too so something is amiss.
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10-24-2010, 09:27 AM   #8
Astra
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I take CalciChew whilst on Pred, which is a bone robber, but this is interesting

http://www.netdoctor.co.uk/medicines/100002946.html

It says this med increases the absorption of Vitamin D and do not take Vit D supps!
No one told me that!
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10-24-2010, 10:50 AM   #9
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Dr. Abraham is actually my Doctor :-).

She did a bone scan on me as a benchmark since I am recently diagnosed.

Thanks for sharing the article, very informative.
10-24-2010, 06:43 PM   #10
David in Seattle
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Joan - To clarify, your link says to "consult your doctor" before taking vitamin D with the calcium carbonate in "CalciChew", as D increases the absorption of calcium (conceivably a problem for someone with kidney problems, particularly stones), rather than not to take the 2 together at all. Vitamin D is required to make the hormone calcitrol, which is needed to absorb calcium. Without it, you end up leaching calcium from your bones. I think they're just being cautious. I know the supplement I take combines D3 w/calcium, and this is pretty common.

It's interesting to note that high dietary levels of protein & sodium can similarly IMPEDE absorption of calcium.

Erika - How interesting that your personal doctor is mentioned. Next time you see her, be sure to tell her you were very impressed with her poster from the American College of Gastroenterology 2010 Annual Scientific Meeting and Postgraduate Course. She'll be stunned that you knew about it!

Last edited by David in Seattle; 10-24-2010 at 06:56 PM.
10-25-2010, 09:15 AM   #11
lseibert
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Thanks David,

Very interesting, I take 4000 IU though out the day.

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[SIZE="1"]Crohn's Disease and IBS
Diagnosed: 2001(symptoms for 22 years prior)
Currently on:
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Surgery: Small bowel strictureplasty 02/19/11 and 11/17/11, then a small bowel resection 4/6/12, Hemicolectomy 9/2016
Supplements:
Multivitamins & Vitamin D3
Prednisone: Never again
Imuran (azathioprine)= Pancreatitis
Entocort EC (Budesonide) and medical adhesives = Rash
Humira=numb feet & hands
10-25-2010, 01:39 PM   #12
Astra
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Thanks David
Hope you're ok? Don't see you around much these days?
xxx
10-25-2010, 02:11 PM   #13
StarGirrrrl
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Have done a little research since this topic came up and Vitamin D is stored by the body. So, for someone who takes a multi vitamin and still is deficient then that certainly seems part of IBD.
10-25-2010, 02:58 PM   #14
Domsmom
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I'm a vit D advocate and the best source I find is DDropps...one less pill to take and since it's in liquid form it's easier for your body to digest. I personally think that vit D deficiancy is related to a lot of diseases, especially in locations that don't get as much sunlight and have more people with auto-immune diseases.
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10-26-2010, 03:12 AM   #15
David in Seattle
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Thanks David
Hope you're ok? Don't see you around much these days?
xxx
Joan - Yeah, I'm OK, thanks for asking. About the same, gut-wise (and other-wise) a bit discouraging at times

So many new names here!

I hope you are well too, and that things are good in Dear Old Blighty
10-26-2010, 03:15 AM   #16
David in Seattle
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Thanks David,

Very interesting, I take 4000 IU though out the day.

Linda - I also divide the dose, taking 1600 w/breakfast & 2400 w/dinner. It's generally good to take it with a meal.
10-26-2010, 08:04 AM   #17
SwtNdSpcy
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I take 50,000 units once a week.
10-26-2010, 08:26 AM   #18
auntee_steph
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I found out a couple years ago that at 28, I officially have osteopenia & have to take 50,000 units twice a month.....I was taking it once a week. Dr said it was from a combo of the crohn's & all the meds that I have had to take over the years.
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