- Email: [email protected]
Vitamin D deficiency in patients with inflammatory bowel disease
S30
Abstracts / Bone 47 (2010) S29–S52
OC03/AHP03 Osteoporosis screening and fracture risk assessment in patients with inflammatory bowel disease P. Bours⁎1, R. Vermeijden2, A. van de Wiel1 1 Department of Internal Medicine, Meander Medical Centre, Amersfoort, Netherlands 2 Department of Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of osteoporosis. The Fracture Risk Assessment Tool (FRAX) evaluates the fracture risk of individuals in the general population. IBD-specific risk factors of osteoporosis remained unclear. In 2008, the Dutch IBD-guideline (IBDG) formulated a high-risk profile of osteoporosis based on IBD-specific risk factors. This study assessed the accuracy of the IBDG-based osteoporosis screening using the FRAX-tool as reference. Methods: Adult IBD patients attending the gastroenterology outpatient unit were screened for osteoporosis using the IBDG and FRAX-method. Patients were not previously diagnosed with osteoporosis. Patient characteristics and medication usage were collected by a questionnaire and the medical record. Fracture risk was calculated without bone mineral density using the online FRAX-tool. Quartiles were stratified based on the 10-year probability of a major osteoporotic (MO) fracture and hip fracture, with the highest quartiles of risk used as reference (SPSS 17.0). According to the IBDG, patients with ≥1 of the following characteristics are at risk of osteoporosis: low energy fracture, multiple fractures in the past, systemic glucocorticoids (>1 year, >7.5 mg daily for six months), IBD since child age, inflammation of small intestines, short bowel syndrome, colestyramine usage, lactose/ calcium deficient diet, postmenopausal women, and age > 55 years in men. Results: 287 Patients were included with a mean age of 48.5 years (SD 14.7). Mean 10-years probability was 4.2% (1.5-20.0%) for MO fracture and 0.9% (0.1-10.0%) for hip fracture. The number of patients classified in the highest risk quartiles for MO and hip fractures, were respectively 70 (24%) and 66 (23%). 195 Patients were classified as high risk by the IBDG. Sixty-six percent of these patients had MO and hip fracture risks in the three lowest quartiles (respectively <4.8% and <0.8%) leading to positive predictive values of respectively 34% and 33%, and negative predictive values of 97% and 100%. Conclusion: Based on the IBDG, two-third of the patients is at risk of osteoporosis. Although most patients in the highest fracture risk quartiles are recognized by the IBDG, this guideline lacks accuracy caused by low positive predictive values. Furthermore, this study shows that high-risk IBDG patients have relatively low fracture risks according to the FRAX-method. Disclosure of Interest: None declared. Keywords: fracture risk assessment, inflammatory bowel disease, osteoporosis
doi:10.1016/j.bone.2010.04.046
OC04/AHP04 Vitamin D deficiency in patients with inflammatory bowel disease P. Bours⁎1, R. Vermeijden2, J. Wielders3, A. van de Wiel1 1 Department of Internal Medicine, Meander Medical Centre, Amersfoort, Netherlands 2 Department of Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands 3 Department of Clinical Chemistry, Meander Medical Centre, Amersfoort, Netherlands
Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of osteoporosis. Vitamin D (VitD) deficiency is known as a risk factor of osteoporosis through its regulating effects on calcium homeostasis. IBD-specific causes of vitD deficiency remain unclear. This cross-sectional study aims to evaluate the prevalence of vitD deficiency, risk factors, and effects of calcium/vitD supplementation in IBD patients. Methods: Adult patients with Crohn's disease (CD) or ulcerative colitis (UC) attending the gastroenterology outpatient unit, were included in October-December 2009. Patient characteristics and medication use were retrieved from medical records. VitD intake was assessed using a questionnaire. Disease activity of IBD was assessed by the Manitoba IBD index. Routine osteoporosis laboratory tests were performed (i.e. hemoglobin, erythrocyte sedimentation rate (ESR), c-reactive protein, calcium, phosphate, creatinine, serum 25(OH)D). Univariate statistical analysis comparing quartiles stratified by 25(OH)D levels was performed (SPSS 17.0, significance set at p < 0.05). VitD deficiency was defined as 25(OH)D <50 nmol/L. Results: 304 IBD patients were included (58% UC, 42% CD). Mean age (±SD) was 48.9 ± 14.8 years. VitD deficiency was seen in 38%. Significant associations were found between low vitD levels and disease activity of IBD (p = 0.035), high BMI (p = 0.003), and elevated blood level of ESR (p = 0.004). Preferred exposure to sun when outdoors (p = 0.046), regular solarium visits (p = 0.005), and recent sun holiday (p = 0.02) were associated with high levels. No significant relation was found between vitD levels and type of IBD (CD vs. UC). One-third of all patients used oral vitD supplementation. Nevertheless, 29% of those patients were still vitD deficient. Conclusion: VitD deficiency is common in this study population of IBD patients. Disease activity, high BMI, and the increased biochemical marker ESR are associated with low vitD levels. The effects of oral vitD supplementation on serum 25(OH)D are poor. Therefore, optimal vitD dosages in IBD patients should be re-evaluated in future studies. Disclosure of Interest: None declared. Keywords: epidemiology, inflammatory bowel disease, vitamin D doi:10.1016/j.bone.2010.04.047
OC05/AHP05 Seasonal variation of serum Vitamin D in Irish community-dwelling older people R. Romero-Ortuno⁎1, J.G. Browne2, M. Healy3, R.A. Kenny4, M.C. Casey2, J.B. Walsh2 1 TRIL Clinic, Trinity College Dublin, Dublin, Ireland 2 MIRA, St James's Hospital, Dublin, Ireland 3 Department of Biochemistry, St James's Hospital, Dublin, Ireland 4 Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland Introduction: Above 35° North, little Vitamin D (VitD) can be produced in winter. In Ireland (53°), little is known about seasonal variation of serum VitD in older people. Methods: 723 communitydwelling people aged ≥60 (mean age 73.7, 73.7% females) from two outpatient clinics (A: comprehensive assessment, N = 456; B: bone health, N = 267). Patients were recruited over seven consecutive seasons (autumn 2007–spring 2009). Monthly global solar radiation data (Dublin) were downloaded from www.met.ie. Results: In N = 723, season (p = 0.001) was a significant predictor of VitD after controlling for age (p = 0.310), gender (p = 0.300), clinic (p = 0.535) and VitD supplementation (p < 0.001). Overall, the pattern of VitD variation paralleled that of the global solar radiation recorded over the period. On average, supplemented subjects (N = 308) had higher
Abstracts / Bone 47 (2010) S29–S52
OC03/AHP03 Osteoporosis screening and fracture risk assessment in patients with inflammatory bowel disease P. Bours⁎1, R. Vermeijden2, A. van de Wiel1 1 Department of Internal Medicine, Meander Medical Centre, Amersfoort, Netherlands 2 Department of Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of osteoporosis. The Fracture Risk Assessment Tool (FRAX) evaluates the fracture risk of individuals in the general population. IBD-specific risk factors of osteoporosis remained unclear. In 2008, the Dutch IBD-guideline (IBDG) formulated a high-risk profile of osteoporosis based on IBD-specific risk factors. This study assessed the accuracy of the IBDG-based osteoporosis screening using the FRAX-tool as reference. Methods: Adult IBD patients attending the gastroenterology outpatient unit were screened for osteoporosis using the IBDG and FRAX-method. Patients were not previously diagnosed with osteoporosis. Patient characteristics and medication usage were collected by a questionnaire and the medical record. Fracture risk was calculated without bone mineral density using the online FRAX-tool. Quartiles were stratified based on the 10-year probability of a major osteoporotic (MO) fracture and hip fracture, with the highest quartiles of risk used as reference (SPSS 17.0). According to the IBDG, patients with ≥1 of the following characteristics are at risk of osteoporosis: low energy fracture, multiple fractures in the past, systemic glucocorticoids (>1 year, >7.5 mg daily for six months), IBD since child age, inflammation of small intestines, short bowel syndrome, colestyramine usage, lactose/ calcium deficient diet, postmenopausal women, and age > 55 years in men. Results: 287 Patients were included with a mean age of 48.5 years (SD 14.7). Mean 10-years probability was 4.2% (1.5-20.0%) for MO fracture and 0.9% (0.1-10.0%) for hip fracture. The number of patients classified in the highest risk quartiles for MO and hip fractures, were respectively 70 (24%) and 66 (23%). 195 Patients were classified as high risk by the IBDG. Sixty-six percent of these patients had MO and hip fracture risks in the three lowest quartiles (respectively <4.8% and <0.8%) leading to positive predictive values of respectively 34% and 33%, and negative predictive values of 97% and 100%. Conclusion: Based on the IBDG, two-third of the patients is at risk of osteoporosis. Although most patients in the highest fracture risk quartiles are recognized by the IBDG, this guideline lacks accuracy caused by low positive predictive values. Furthermore, this study shows that high-risk IBDG patients have relatively low fracture risks according to the FRAX-method. Disclosure of Interest: None declared. Keywords: fracture risk assessment, inflammatory bowel disease, osteoporosis
doi:10.1016/j.bone.2010.04.046
OC04/AHP04 Vitamin D deficiency in patients with inflammatory bowel disease P. Bours⁎1, R. Vermeijden2, J. Wielders3, A. van de Wiel1 1 Department of Internal Medicine, Meander Medical Centre, Amersfoort, Netherlands 2 Department of Gastroenterology, Meander Medical Centre, Amersfoort, Netherlands 3 Department of Clinical Chemistry, Meander Medical Centre, Amersfoort, Netherlands
Introduction: Patients with inflammatory bowel disease (IBD) have an increased risk of osteoporosis. Vitamin D (VitD) deficiency is known as a risk factor of osteoporosis through its regulating effects on calcium homeostasis. IBD-specific causes of vitD deficiency remain unclear. This cross-sectional study aims to evaluate the prevalence of vitD deficiency, risk factors, and effects of calcium/vitD supplementation in IBD patients. Methods: Adult patients with Crohn's disease (CD) or ulcerative colitis (UC) attending the gastroenterology outpatient unit, were included in October-December 2009. Patient characteristics and medication use were retrieved from medical records. VitD intake was assessed using a questionnaire. Disease activity of IBD was assessed by the Manitoba IBD index. Routine osteoporosis laboratory tests were performed (i.e. hemoglobin, erythrocyte sedimentation rate (ESR), c-reactive protein, calcium, phosphate, creatinine, serum 25(OH)D). Univariate statistical analysis comparing quartiles stratified by 25(OH)D levels was performed (SPSS 17.0, significance set at p < 0.05). VitD deficiency was defined as 25(OH)D <50 nmol/L. Results: 304 IBD patients were included (58% UC, 42% CD). Mean age (±SD) was 48.9 ± 14.8 years. VitD deficiency was seen in 38%. Significant associations were found between low vitD levels and disease activity of IBD (p = 0.035), high BMI (p = 0.003), and elevated blood level of ESR (p = 0.004). Preferred exposure to sun when outdoors (p = 0.046), regular solarium visits (p = 0.005), and recent sun holiday (p = 0.02) were associated with high levels. No significant relation was found between vitD levels and type of IBD (CD vs. UC). One-third of all patients used oral vitD supplementation. Nevertheless, 29% of those patients were still vitD deficient. Conclusion: VitD deficiency is common in this study population of IBD patients. Disease activity, high BMI, and the increased biochemical marker ESR are associated with low vitD levels. The effects of oral vitD supplementation on serum 25(OH)D are poor. Therefore, optimal vitD dosages in IBD patients should be re-evaluated in future studies. Disclosure of Interest: None declared. Keywords: epidemiology, inflammatory bowel disease, vitamin D doi:10.1016/j.bone.2010.04.047
OC05/AHP05 Seasonal variation of serum Vitamin D in Irish community-dwelling older people R. Romero-Ortuno⁎1, J.G. Browne2, M. Healy3, R.A. Kenny4, M.C. Casey2, J.B. Walsh2 1 TRIL Clinic, Trinity College Dublin, Dublin, Ireland 2 MIRA, St James's Hospital, Dublin, Ireland 3 Department of Biochemistry, St James's Hospital, Dublin, Ireland 4 Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland Introduction: Above 35° North, little Vitamin D (VitD) can be produced in winter. In Ireland (53°), little is known about seasonal variation of serum VitD in older people. Methods: 723 communitydwelling people aged ≥60 (mean age 73.7, 73.7% females) from two outpatient clinics (A: comprehensive assessment, N = 456; B: bone health, N = 267). Patients were recruited over seven consecutive seasons (autumn 2007–spring 2009). Monthly global solar radiation data (Dublin) were downloaded from www.met.ie. Results: In N = 723, season (p = 0.001) was a significant predictor of VitD after controlling for age (p = 0.310), gender (p = 0.300), clinic (p = 0.535) and VitD supplementation (p < 0.001). Overall, the pattern of VitD variation paralleled that of the global solar radiation recorded over the period. On average, supplemented subjects (N = 308) had higher