Mandibular trabecular bone structure in adults with Crohn's disease

Crohn's disease (CD) is associated with reduced bone mineral density. The main objective of the present study was to assess the mandibular trabecular bone quality and to compare our findings with those among sex- and age-matched controls. Furthermore, background variables known to be significant for bone density were compared. Intraoral radiographs of 49 Crohn's patients (23-61 years old) and 49 age- and sex-matched controls were evaluated. Mandibular trabecular pattern was classified as either sparse, mixed dense plus sparse, or dense. Furthermore, two computer-based methods analyzed the transitions from trabecula to intertrabecular spaces and the size and number of these spaces. Differences in continuous background variables were tested with Student's two-sample t test and ordinal variables with Mann-Whitney U test or Kruskal-Wallis nonparametric tests. All three methods to evaluate bone structure seen on dental radiographs showed significantly sparser trabeculation in Crohn's patients than in the control group. The Crohn's patients were heavier, more often smokers, and more frequently had mothers who developed fragility fractures. Furthermore, the Crohn's patients, especially smokers, had a significantly higher fracture rate than the matched control group but no significant relationship was found between trabeculation pattern and fracture. The results of this investigations indicated that trabecular bone is significantly sparser in subjects with Crohn's disease compared to a matched control group. An early identification of CD patients with sparse trabeculation and appropriate advice concerning nutrition and exercise may lead to less fractures and medication in the future.