Inflammatory bowel disease and osteoporosis

Patients with inflammatory bowel disease are at increased risk to develop osteoporosis due to the underlying inflammatory process, as a result of the intestinal dysfunction and as a consequence of the treatment given to counteract the disease. Furthermore, patients with inflammatory bowel disease presumably share with the general population other common risk factors for osteoporosis, e.g. heredity, smoking, inactivity and hormone deficiency. Most recent investigations demonstrate a reduced bone mineral density in inflammatory bowel disease patients, often more apparent in the femoral neck than in the lumbar spine, but there are no controlled fracture studies in these patients. There is , at the bone tissue level, evidence for a negative remodelling balance, i.e., increased resorption with or without suppressed formation and it is commonly found that corticosteroid use significantly contributes to bone loss. Although controlled studies are few, patients with inflammatory bowel disease should be informed about osteoporosis, have their bone mineral density measured and receive general advice including hormone replacement therapy, calcium and vitamin D. In more severe cases antiresorptive therapy might be instituted under close supervision.