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- Title
Altered Bone Metabolism in Inflammatory Bowel Disease.
- Authors
Bischoff, Stephan C.; Herrmann, Annette; Göke, Michael; Manns, Michael P.; Von zur Mühlen, Alexander; Brabant, Georg
- Abstract
A reduced bone mineral density has been reported in inflammatory bowel disease (IBD). Objective: To assess the mechanisms of bone disease in IBD. Methods: We studied in 90 patients (61 with Crohn's disease, 22 with ulcerative colitis, 7 with indeterminate colitis) biochemical markers of bone metabolism in serum and bone mineral density by peripheral quantitative computed tomography at the forearm. Results: Forty-five percent of the patients had a reduced bone density (Z score < - 1). Serum calcium was normal in most patients, vitamin D deficiency was documented in 17%. Osteocalcin, a serum marker of bone formation, was decreased in 26% (1.2 ± 0.1 ng/ml). whereas the carboxyterminal cross-linked telopeptide of type 1 collagen (ICTP), a recently described serum parameter of bone breakdown, was stimulated in 38% (10.4 ± 2.3 µg/L). Of 33 patients with increased ICTP levels, 19 showed a decreased bone density (Z score < - 1), and 2 of them never received steroids. An active status of the underlying disease in most patients with increased ICTP levels suggests a direct effect of the underlying IBD. In the whole series of patients with a history of active disease (n = 34), 47% had signs of an increased hone degradation (ICTP > 5 µg/L; mean, 12.9 ± 4.7 µg/L). Data derived from a retrospective survey of 245 patients with IBD suggest that the prevalence of bone fractures in IBD is unexpectedly high, particularly in patients with a long duration of disease, frequent active phases, and high cumulative doses of corticosteroid intake. Conclusions: Several mechanisms may be involved in IBD-associated bone disease: (1) a high inflammatory activity directly induces hone degradation via yet unknown pathways, (2) treatment with corticosteroids may exert catabolic effects on tbe bone, or (3) malabsorption and vitamin D deficiency may activate bone turnover.
- Publication
American Journal of Gastroenterology (Springer Nature), 1997, Vol 92, Issue 7, p1157
- ISSN
0002-9270
- Publication type
Academic Journal