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Bone loss in patients with Crohn's disease: A longterm-follow up study
6 months. All patients received placebo or risedronate 2.5 or 5 mg daily for 1 year while continuing GC therapy. Patients in the "prevention" study received 500 mg/day of elemental calcium while those on the "treatment" study received 1000 mg of elemental calcium and 400 IU vitamin D daily. Change in lumbar spine BMD from baseline to 1 year was the primary efficacy endpoint. Results: At 12 months, a significant increase in BMD at the lumbar spine (2.9%, p
3187 Disease Severity Predicts Done Loss: A LongJlodinal Study in Inflammatory Bowel Disease Patients Sandra D. Henderson, Satvinder S. Dhaliwa], Neville E. Hoffman, Richard L Prince, Sir Charles Gairdner Hosp, Perth Australia BACKGROUND:Osteoporosis is common in inflammatory bowel disease (IBD) patients (3159%). The risk factors for continuing increased bone loss have not been delineated. AIM: To determine the rate of bone loss in patients with IBD, and the factors which predict bone loss. METHOD: 57 Crohn's and 43 ulcerative colitis patients were followed over a mean period of 14 months. Bone density was measured at the hip and spine using QDR 4500 technology, at the commencement and completion of the study period. The two bone density results were considered to be significantly different if the difference between them was greater than the measurement error for that site. At study initiation cumulative corticosteroid consumption in grams was determined by structured patient interview and overall disease severity (ranked mild/moderate/severe) was rated by the treating Gastroenterologist. During the study total number of symptomatic months, and corticosteroid and azathioprine use were noted. Change in weight was measured. Data was analysed using the Student unpaired T test and Fisher exact test for ceteoor~l data. RESULTS:The mean annual change in bone density was 0.004 g/cn~ (0.4%) at the spine, and -0.0004 O/cm2 (-0.1%) at the hip. 18% of patients had an absolute loss of bone density, 24% gained bone and 58% remained stable. 49 patients had osteopenia (T<-I) on the initial scan. These patients were significantly more likely to lose bone density (p
Risk of Fradma in Crohn's O_~_L~e_:A Population-Based Study. Edward V. Loflus Jr, Cynthia S. Crowson, William J. Sandbom, William J. Tremaine, William M. O'Fallon, L. Joseph Melton III. Mayo Clin, Rochester, MN BACKGROUND: Osteoporosis is common in patients with Crohn's disease (CD), but less is known about the risk of actual bone fracture in CD patients. METHODS:The combined inpatient and outpatient medical records (including all radiographic reports) of the 238 Olmsted County, MN residents diagnosed with CD between 1940 and 1993 were reviewed for evidence of subsequent fractures. The medical records of a control group of County residents matched on soe and gender to each case were also reviewed. The risk ratio of fracture in CD relative to controls was estimated by Cox proportional hazards regression. The analysis was also stratified by the need for corticosteroids within the first year after diagnosis (n = 52), and by the presence of small bowel involvement (n = 155). The cumulative incidence of fracture from time after diagnosis was estimated using the Kaplan-Meier method. RESULTS: The records of 238 cases and 238 controls were reviewed. The table depicts the number of cases and controls who had fractures, and the corresponding risk ratio with 95% confidence intervals (95% CI). The cumulative incidence of any fracture from time of diagnosis was 11% at 5 years, 17% at 10 years, and 36% at 20 years versus 9%, 19%, and 32%, respectively, in controls (p>0.7, log-rank). CONCLUSIONS:In this population-based inception cohort of patients with Crohn's disease, the risk of bone fracture was not elevated relative to age- and gender-matched controls. Use of corticosteroids within the first year after diagnosis and small bowel involvement did not appear to influence this risk.
3188
Numb~ of patientswith Fracturesand CorrespondingRiskRatios Low Bone Mineral Density in Association With increased Done ResorMion in Patients With Inflammatory Bowel Disease At Diagnosis Terence Wong, Derek Smith, David Simpson, Anthony Coakley, Kent and Canterbury Hosp, Canterbury United Kingdom; Caje Moniz, King's Coil Hosp, London United Kingdom; Edward J. Lamb, Andrew F. Muller, Kent and Canterbury Hosp, Canterbury United Kingdom
Overall. Hip/wflMJspine Overall. Any fracture Steroids lstyr - Hipkw'/sp Steroids 1st yr- Any fracture Small bowel - Hip/wr/sp Small bowel - Any fracture
Introduction Inflammatory bowel disease (IBD) is associated with low bone mineral density (BMD). The pathogenesis of this is uncertain, but has been attributed to corticosteroid therapy, or disturbances in calcium homeostasis. The aims of the present study were to determine the BMD in IBD patients at initial presentation prior to corticosteroid administration, and the degree of osteoclast, and osteoblast activity by serum, and urinary bone markers. Patients and Methods 34 patients (19M, 15F, mean age 41 yrs; range 19-72 yrs) with IBD (21 ulcerative colitis [UC], 13 Crohn s disease [CD]) were studied at presentation, before corticosteroicl therapy, and compared with a control group of 17 patients with irritable bowel syndrome (18S), and manufacturers reference ranges. Dual energy x ray absorptiometry (DEXA) was used to measure BMD at the femoral neck, and lumbar spine. Plasma alkaline phosphstase, osteocalcin, and urinary deoxypyridinoline(DPD) was measured to determine osteoblast, and osteoclast activity. Differences between groups were determined using the student t test. ResultsAt diagnosis patients with IBD had lower lumbar spine Z scores (mean -1.05 + 1.54[SD]) compared with reference ranges (p
Cases
Controls
Risk Ratio (95% CI)
30 63 7 14 20 44
27 67 8 15 15 43
1.1 (0.6-1.8) 0.9 (0.6-1.3) 1.1 (0.4-2.9) 1.0 (0.6-2.1) 1.3 (0.7-2.6) 1.0 (0.7-1.6)
318g Screening for Octeoporesis in inflammatory Bowel Disease: A British Perspective Palani Sathish Babu, Sou Mak, Richard Vat Heatley, St James's Univ Hosp, Leeds United Kingdom Background: Osteoporosisis a well established complication of IBD and the prevalence is reported to be high. Early detection of osteoporosis by screening can reduce morbidity and associated costs. The British Society of Gastroenterology has published guidelines for screening and management of osteoporosis in IBD patients. (1) Aim: To examine the frequency of screening for osteoporosis in our IBD patients and to determine whether the rate of screening had increased following the publication of guidelines. Methods: The case notes of patients attending our muifidisciplinary IBD clinic were prospectively surveyed. Data were collected for duration of disease, steroid use, associated comorbid factors for osteoporosis, referrals for a DEXA bone densitometry scan and management. Results: A total of 100 patients (58 UC & 42 Crohns) were studied both before and after publication of the BSG guidelines. There were 42 male and 58 female patients. The mean age for males and females were 50.4 yrs (25-83) & 47 yrs (18-82) for UC and 43.3 yrs (21-63) & 47.2 yrs (23-84) for Crohns. The median disease duration was 156 months (19-564) for UC and 156 months (16-444) for Crohns respectively. 36.2% (21 patients) of UC and 45.2% (19 patients) of Crohns had required steroids for flare-ups in the previous 12 months, with a mean flare up rate of 1.52 (1-4) and 1,68 (1-3) for UC and Crohns. 8.6% of UC and 38% of Crohns had required
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3187 Disease Severity Predicts Done Loss: A LongJlodinal Study in Inflammatory Bowel Disease Patients Sandra D. Henderson, Satvinder S. Dhaliwa], Neville E. Hoffman, Richard L Prince, Sir Charles Gairdner Hosp, Perth Australia BACKGROUND:Osteoporosis is common in inflammatory bowel disease (IBD) patients (3159%). The risk factors for continuing increased bone loss have not been delineated. AIM: To determine the rate of bone loss in patients with IBD, and the factors which predict bone loss. METHOD: 57 Crohn's and 43 ulcerative colitis patients were followed over a mean period of 14 months. Bone density was measured at the hip and spine using QDR 4500 technology, at the commencement and completion of the study period. The two bone density results were considered to be significantly different if the difference between them was greater than the measurement error for that site. At study initiation cumulative corticosteroid consumption in grams was determined by structured patient interview and overall disease severity (ranked mild/moderate/severe) was rated by the treating Gastroenterologist. During the study total number of symptomatic months, and corticosteroid and azathioprine use were noted. Change in weight was measured. Data was analysed using the Student unpaired T test and Fisher exact test for ceteoor~l data. RESULTS:The mean annual change in bone density was 0.004 g/cn~ (0.4%) at the spine, and -0.0004 O/cm2 (-0.1%) at the hip. 18% of patients had an absolute loss of bone density, 24% gained bone and 58% remained stable. 49 patients had osteopenia (T<-I) on the initial scan. These patients were significantly more likely to lose bone density (p
Risk of Fradma in Crohn's O_~_L~e_:A Population-Based Study. Edward V. Loflus Jr, Cynthia S. Crowson, William J. Sandbom, William J. Tremaine, William M. O'Fallon, L. Joseph Melton III. Mayo Clin, Rochester, MN BACKGROUND: Osteoporosis is common in patients with Crohn's disease (CD), but less is known about the risk of actual bone fracture in CD patients. METHODS:The combined inpatient and outpatient medical records (including all radiographic reports) of the 238 Olmsted County, MN residents diagnosed with CD between 1940 and 1993 were reviewed for evidence of subsequent fractures. The medical records of a control group of County residents matched on soe and gender to each case were also reviewed. The risk ratio of fracture in CD relative to controls was estimated by Cox proportional hazards regression. The analysis was also stratified by the need for corticosteroids within the first year after diagnosis (n = 52), and by the presence of small bowel involvement (n = 155). The cumulative incidence of fracture from time after diagnosis was estimated using the Kaplan-Meier method. RESULTS: The records of 238 cases and 238 controls were reviewed. The table depicts the number of cases and controls who had fractures, and the corresponding risk ratio with 95% confidence intervals (95% CI). The cumulative incidence of any fracture from time of diagnosis was 11% at 5 years, 17% at 10 years, and 36% at 20 years versus 9%, 19%, and 32%, respectively, in controls (p>0.7, log-rank). CONCLUSIONS:In this population-based inception cohort of patients with Crohn's disease, the risk of bone fracture was not elevated relative to age- and gender-matched controls. Use of corticosteroids within the first year after diagnosis and small bowel involvement did not appear to influence this risk.
3188
Numb~ of patientswith Fracturesand CorrespondingRiskRatios Low Bone Mineral Density in Association With increased Done ResorMion in Patients With Inflammatory Bowel Disease At Diagnosis Terence Wong, Derek Smith, David Simpson, Anthony Coakley, Kent and Canterbury Hosp, Canterbury United Kingdom; Caje Moniz, King's Coil Hosp, London United Kingdom; Edward J. Lamb, Andrew F. Muller, Kent and Canterbury Hosp, Canterbury United Kingdom
Overall. Hip/wflMJspine Overall. Any fracture Steroids lstyr - Hipkw'/sp Steroids 1st yr- Any fracture Small bowel - Hip/wr/sp Small bowel - Any fracture
Introduction Inflammatory bowel disease (IBD) is associated with low bone mineral density (BMD). The pathogenesis of this is uncertain, but has been attributed to corticosteroid therapy, or disturbances in calcium homeostasis. The aims of the present study were to determine the BMD in IBD patients at initial presentation prior to corticosteroid administration, and the degree of osteoclast, and osteoblast activity by serum, and urinary bone markers. Patients and Methods 34 patients (19M, 15F, mean age 41 yrs; range 19-72 yrs) with IBD (21 ulcerative colitis [UC], 13 Crohn s disease [CD]) were studied at presentation, before corticosteroicl therapy, and compared with a control group of 17 patients with irritable bowel syndrome (18S), and manufacturers reference ranges. Dual energy x ray absorptiometry (DEXA) was used to measure BMD at the femoral neck, and lumbar spine. Plasma alkaline phosphstase, osteocalcin, and urinary deoxypyridinoline(DPD) was measured to determine osteoblast, and osteoclast activity. Differences between groups were determined using the student t test. ResultsAt diagnosis patients with IBD had lower lumbar spine Z scores (mean -1.05 + 1.54[SD]) compared with reference ranges (p
Cases
Controls
Risk Ratio (95% CI)
30 63 7 14 20 44
27 67 8 15 15 43
1.1 (0.6-1.8) 0.9 (0.6-1.3) 1.1 (0.4-2.9) 1.0 (0.6-2.1) 1.3 (0.7-2.6) 1.0 (0.7-1.6)
318g Screening for Octeoporesis in inflammatory Bowel Disease: A British Perspective Palani Sathish Babu, Sou Mak, Richard Vat Heatley, St James's Univ Hosp, Leeds United Kingdom Background: Osteoporosisis a well established complication of IBD and the prevalence is reported to be high. Early detection of osteoporosis by screening can reduce morbidity and associated costs. The British Society of Gastroenterology has published guidelines for screening and management of osteoporosis in IBD patients. (1) Aim: To examine the frequency of screening for osteoporosis in our IBD patients and to determine whether the rate of screening had increased following the publication of guidelines. Methods: The case notes of patients attending our muifidisciplinary IBD clinic were prospectively surveyed. Data were collected for duration of disease, steroid use, associated comorbid factors for osteoporosis, referrals for a DEXA bone densitometry scan and management. Results: A total of 100 patients (58 UC & 42 Crohns) were studied both before and after publication of the BSG guidelines. There were 42 male and 58 female patients. The mean age for males and females were 50.4 yrs (25-83) & 47 yrs (18-82) for UC and 43.3 yrs (21-63) & 47.2 yrs (23-84) for Crohns. The median disease duration was 156 months (19-564) for UC and 156 months (16-444) for Crohns respectively. 36.2% (21 patients) of UC and 45.2% (19 patients) of Crohns had required steroids for flare-ups in the previous 12 months, with a mean flare up rate of 1.52 (1-4) and 1,68 (1-3) for UC and Crohns. 8.6% of UC and 38% of Crohns had required
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