Factors Behind Low Bone Density in IBD

Low vitamin D and corticosteroids were associated with low bone density in IBD patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Patients with inflammatory bowel disease have an increased risk of low bone density. Vitamin deficiency appears to be only one factor increasing the risk.

The loss of minerals from bones can be due to age, disease and nutritional status. The result is lower bone density and weaker bones that are at greater risk for fracture.

Investigators recently studied the link between vitamin D deficiency and bone loss in people with inflammatory bowel diseases (IBD), including Crohn's disease and ulcerative colitis.

These researchers found that both low levels of vitamin D in the blood and the corticosteroids commonly used to treat IBD were associated with low bone density.

"Ask your doctor how to reduce bone loss."

Bincy P. Abraham, MD, from the Texas Children’s Hospital in Houston, TX, was the lead author of this study.

IBD patients between the ages of 17 and 70 took part in this research. Of the total 168 IBD patients in the study, 105 had Crohn’s disease and 61 had ulcerative colitis. A total of 58 percent of participants were women, and 73 percent were Caucasian, 11 percent were African American and 8 percent were Asian.

The researchers gave the study participants a bone scan to test for bone density. Osteopenia is a condition in which bones are less dense than normal, making these bones weaker. Osteopenia can progress to osteoporosis, a condition in which there is a significant amount of bone loss. The bone loss in osteoporosis gets worse with time, and patients with osteoporosis have a high risk for bone fractures.

A normal bone density score, called a T score, is between +1 and -1. Patients with a T score less than -1 were called osteopenic, and people with a bone density of less than –2.5 were considered to have osteoporosis.

In this study, the researchers considered patients with either osteopenia or osteoporosis to have low bone density.

The research team also measured vitamin D in the blood. Normal blood levels of vitamin D are between 30 and 74 ng/ml. Blood concentrations of vitamin D between 20 and 30 ng/ml were considered low, and levels less than 20 ng/ml were considered deficient.

In this study, 33 percent of the patients had osteopenia and 8 percent had osteoporosis.

Osteoporosis was twice as common in men with IBD as in women. Asian patients had four times the chance of having low bone density as Caucasians.

Many IBD patients take corticosteroids to reduce the inflammation the disease causes in their bowels. Dr. Abraham and team found that IBD patients who took corticosteroids had twice the risk of having low bone density as those who did not take corticosteroids.

IBD patients with low levels of vitamin D had twice the risk of having low bone density as the IBD patients with normal levels of vitamin D. Patients with vitamin D deficiency had nearly three times the risk of having low bone density as those with normal levels of vitamin D.

Referring to IBD patients who may not have the traditional risk factors of age, family history or postmenopausal age, the authors wrote, “Evaluation of vitamin D levels and [increasing vitamin D levels to greater than 30 ng/ml] and limiting corticosteroid use may help reduce the risk of low bone mineral density in these patients.”

This study was published in the March issue of Digestive Disease and Sciences.

The researchers disclosed no conflicts of interest.

Review Date: 
March 19, 2014
Last Updated:
March 19, 2014