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Park, Jung, Noh, Kang, Jung, Kim, Jung, Shim, Kim, Yoo, Moon, and Hong: Analysis of Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease
Original Article

Korean J Gastroenterol 2010;55(4):237-244.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.55.4.237

Analysis of Risk Factors for Low Bone Mineral Density in Patients with Inflammatory Bowel Disease

Jae Jung Park, M.D., Sung-Ae Jung, M.D., Young Wook Noh, M.D., Min-Jung Kang, M.D., Ji Min Jung, M.D., Seong-Eun Kim, M.D., Hye-Kyung Jung, M.D., Ki-Nam Shim, M.D., Tae Hun Kim, M.D., Kwon Yoo, M.D., Il Hwan Moon, M.D., Young Sun Hong, M.D.

Department of Internal Medicine, Ewha Womans University School of Medicine, Ewha Medical Research Institute, Seoul, Korea

Correspondence to: Sung-Ae Jung, M.D. Department of Internal Medicine, Division of Gastrointestinal Diseases, Ewha Womans University Mok-dong Hospital, 911-1, Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: +82-2-2650-5272, Fax: +82-2-2655-2076 E-mail: jassa@ewha.ac.kr

Received 25 September 2009       Accepted 22 January 2010

Copyright © 2010 The Korean Journal of Gastroenterology

Abstract

Background/Aims

Several clinical risk factors for low bone mineral density (BMD) in the patients with inflammatory bowel disease (IBD) have been suggested. However, its prevalence and pathophysiology in Korean population have not been fully studied. The aim of this study was to investigate the prevalence and risk factors for low BMD in Korean IBD patient.

Methods

BMD of the lumbar spine and femur was evaluated using du-al-energy X-ray absorptiometry in 30 patients with IBD. Biochemical parameters of bone metabolism, such as serum calcium, phosphorus, osteocalcin, and deoxypyridinoline were measured. The associations between low BMD and clinical parameters such as disease duration, disease activity, drug history, body mass index (BMI), and others were evaluated retrospectively using medical records.

Results

Low BMD at the lumbar spine or femur was observed in 63.3% of the patients, and there was no significant difference between the patients with Crohn's disease and ulcerative colitis. Clinical and biochemical parameters were irrelevant to BMD. In the patients without glucocorticoid treatment prior to BMD measurement, already 50.0% of patients had low BMD.

Conclusions

Low BMD is a common feature in Korean IBD patients, even those who do not use glucocorticoid. The multiple factors may be involved in the pathogenesis of low BMD. Therefore, BMD should be examined in all IBD patients, irrespective of glucocorticoid treatment.

Keywords: Inflammatory bowel disease, Bone mineral density, Crohn’, s disease, Ulcerative colitis

REFERENCES

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Table 1.
Clinical Characteristics of IBD Patients
Inflammatory bowel disease (n=30) Crohn's disease (n=17) Ulcerative colitis (n=13)
Sex (M:F) 24:6 16:1 8:5
Age (years) 30±9 (18-50) 27±7 (18-41) 33±9 (18-50)
Body mass index (kg/m2) 21.5±2.2 (17.8-27.7) 21.4±1.9 (17.8-25.0) 21.6±2.5 (18.8-27.7)
Smoker:Non somker (number) 3:18 2:12 1:6
Duration of disease (months) 56.4±35.9 (12.0-132.0) 59.2±40.9 (12.0-132.0) 53.1±30.3 (12.0-108.0)
Disease location
Small bowel involvement 8 8 0
Colon only 22 9 13
Pancolitis 6
Left colitis 2
Proctitis 5
Comobidity 3 3 0
Small bowel resection 2 2 0
Number of patients who has episodic 13 6 7
period prior to the measurement
Glucocorticoid use 22 13 9
Duration of using glucocorticoid (months) 13.3±24.1 (1-118) 15.4±31.2 (1-118) 10.2±7.1 (1-24)
Glucocorticoid cumulative dose (g) 3.6±2.4 (0.8-10) 3.1±2.4 (1.3-10) 4.3±2.4 (0.8-7.5)
CRP (NR 0-0.3 mg/dL) 0.8±0.8 (0.02-3.53) 1.1±0.9∗ (0.02-8.4) 0.4±0.5 (0.02-1.58)
Immunosuppressive drug 2 2 0

NR, normal range.

Data are presented as group mean± SD (range).

All other variables tested showed no significant differences between the groups.

∗ p＜0.05, Significance values compared Crohn's disease with ulcerative colitis.

Table 2.
Measurements of BMD
Inflammatory bowel disease (n=30) Crohn's disease (n=17) Ulcerative colitis (n=13) p-value
BMD in lumbar spine
   Z score −1.06±1.03 (−3.00-0.90) −0.92±1.24 (−3.00-0.90) −1.24±0.68 (−2.10-0.70) 0.46
   Low Z score 16 (53.3%) 7 (43.7%) 9 (56.3%)
   T score −1.06±1.15 (−2.50-1.30) −0.96±1.20 (−2.50-0.90) −1.16±1.13 (−2.50-1.30) 0.50
   Low T score 12 (40.0%) 6 (50.0%) 6 (50.0%)
BMD in femur neck
   Z score −0.29±0.76 (−1.60-0.80) −0.23±0.73 (−1.30-0.80) −0.37±0.81 (−1.60-0.70) 0.55
   Low Z score 7 (23.3%) 3 (17.6%) 4 (30.7%)
   T score −0.28±0.76 (−1.90-1.00) −0.21±0.65 (−1.50-0.60) −0.36±0.90 (−1.90-1.00) 0.45
   Low T score 6 (24.0%) 2 (33.3%) 4 (66.7%)

BMD, bone mineral density.

Data are presented as group mean± SD (range).

p-values, compared Crohn's disease with ulcerative colitis.

Table 3.
Comparison of Clinical and Biochemical Parameters between Patients with a Normal and a Low BMD
Normal BMD (n=11) Low BMD (n=19) p-value
Sex (M:F) 8:3 16:3 0.45
Age (years) 29±9 (19-45) 30±8 (18-50) 0.15
CD:UC 7:4 10:9 0.39
Body mass index (kg/m2) 21.7±1.8 (18.8±23.9) 21.4±2.4 (17.8±27.7) 0.33
Disease duration (months) 56.7±40.9 (12.0-132.0) 56.2±33.9 (12.0-132.0) 0.54
Smoker:Non smoker (number) 1:8 2:13 0.86
CRP (NR 0-0.3 mg/dL) 0.7±0.7 (0.02-1.86) 1.5±2.1 (0.02-8.4) 0.33
Number of patients who use glucocorticoid 8 (72.7) 14 (73.6) 0.95
prior to BMD measurement (%)
Duration of using glucocorticoid (months) 20.8±39.6 (1-118) 9.0±6.4 (1-24) 0.81
glucocorticoid cumulative dose (g) 3.3±2.9 (0.8-10) 3.8±2.1 (1.5-7.6) 0.40
Number of patients who has episodic period 5 8 0.80
prior to the BMD measurement

BMD, bone mineral density; CD, Crohn's disease; UC, ulcerative colitis; NR, normal range.

Data are presented as group mean± SD (range).

Significance values (p＜0.05) by Mann-Whitney test, compared normal BMD with low BMD.

Table 4.
Comparison of Bone Biochemical Markers between Patients with a Normal and a Low BMD
Normal BMD (n=11) Low BMD (n=19) p-value
Serum calcium (NR 8.2-10.5 mg/dL) 8.5±0.3 (8.1-9.3) 8.6±0.3 (7.9-9.3) 0.48
Serum phosphorus (NR 2.3-4.5 mg/dL) 3.7±0.6 (2.9-4.8) 3.4±0.5 (2.6-4.5) 0.49
Serum osteocalcin (NR 8.0-36.0 ng/mL) 21.1±13.9 (8.1-49.7) 17.3±7.9 (2.8-28.6) 0.40
Serum deoxypyridinoline (NR 2.3-5.4 nM/mM) 6.6±2.3 (4.2-10.2) 5.1±1.6 (2.7-8.7) 0.47

BMD, bone mineral density; CD, Crohn's disease; UC, ulcerative colitis; NR, normal range.

Data are presented as group mean± SD (range).

Significance values (p＜0.05) by Mann-Whitney test, compared normal BMD with low BMD.

Table 5.
Measurement of Bone Biochemical Markers
Bone biochemical marker (normal range) Inflammatory bowel disease (n=30) Crohn's disease (n=17) U Ulcerative colitis (n=13)
Serum calcium (NR 8.2-10.5 mg/dL) 8.6±0.3 (7.9-9.3) 8.6±0.3 (8.1-9.3) 8.6±0.3 (7.9-9.1)
Serum phosphorus (NR 2.3-4.5 mg/dL) 3.5±0.6 (2.6-4.8) 3.6±0.6 (2.7-4.8) 3.4±0.5 (2.6-4.5)
Serum osteocalcin (NR 8.0-36.0 ng/mL) 18.7±10.4 (2.8-49.7) 23.8±10.0∗ (9.6-49.7) 12.7±7.5 (2.8-28.6)
Serum deoxypyridinoline (NR 2.3-5.4 nM/mM) 5.7±2.0 (3.4-10.2) 5.6±2.2 (3.4-10.2) 5.8±1.9 (2.7-9.6)

NR, normal range.

Data are presented as group mean± SD (range).

All other variables tested showed no significant differences between the groups.

∗ p＜0.05, compared crohn's disease with ulcerative colitis.

Table 6.
Comparison of BMD and Bone Biochemical Markers according to the Glucocorticoid Treatment
Total (n=30) Glucocorticoid treatment (n=22) No glucocorticoid treatment (n=8) p
Z score −0.9±1.1 (−2.8-1.4) −1.0±1.0 (−3.0-1.4) −0.8±1.3 (−2.8-1.1) 0.82
Serum calcium (NR 8.2-10.5 mg/dL) 8.6±0.3 (7.9-9.3) 8.6±0.3 (7.9-9.1) 8.6±0.4 (8.1-9.3) 1.00
Serum phosphorous (NR 2.3-4.5 mg/dL) 3.5±0.6 (2.6-4.8) 3.5±0.5 (2.7-4.7) 3.5±0.7 (2.6-4.8) 0.94
Serum osteocalcin (NR 8.0-36.0 ng/mL) 18.7±10.4 (2.8-49.7) 17.0±8.7 (2.8-33.0) 22.9±13.7 (9.0-49.7) 0.42
Serum deoxypyridinoline (NR 2.3-5.4 nM/mM) 5.7±2.0 (2.7-10.2) 5.4±1.7 (3.4-8.7) 6.4±2.6 (2.7-10.2) 0.22

BMD, bone mineral density; NR, normal range.

Data are presented as group mean± SD (range).

Significance values (p＜0.05) by using Mann-Whitney test, compared glucocorticoid treatment with no glucocorticoid treatment.

Table 7.
Subgroup Analysis of No Glucocorticoid Treatment Group
Diagnosis Age Sex Disease duration (months) BMI Smoking Episodic period prior to BMD (number) CRP (NR 0-0.3 mg/dL) BMD
1 CD 23 M 84 17.8 N 0 1.86 Low
2 CD 19 M 36 19.3 N 0 0.73 Normal
3 CD 26 M 132 22.7 N 1 1.41 Normal
4 UC 42 M 60 20.2 NC 1 0.69 Low
5 UC 34 M 12 27.7 NC 1 0.02 Normal
6 UC 18 F 60 18.8 N 1 0.03 Normal
7 UC 32 M 60 18.8 NC 0 0.03 Low
8 UC 45 F 12 23.1 N 0 0.87 Low

BMD, bone mineral density; BMI, body mass index; CD, Crohn's disease; UC, ulcerative colitis. N, no smoking history; NC, not checked.

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