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.
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.
