Colorectal Surgical Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Århus C, Denmark.
Colorectal Surgical Unit, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Århus C, Denmark.
J Crohns Colitis. 2014 Feb;8(2):107-12. doi: 10.1016/j.crohns.2013.07.001. Epub 2013 Jul 18.
Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the preferred surgical treatment for ulcerative colitis (UC). Little is known of how the operation affects bone metabolism and fracture risk. The aim of this retrospective cohort study was to investigate fracture risk and serum markers of bone metabolism following IPAA in a national cohort of Danish UC patients.
Diagnostic codes for 1757 patients and 8785 controls were obtained from the National Patient Register while blood results were collected from a regional database. Postoperative fracture free survival was evaluated on a Kaplan-Meier plot. Fracture hazard ratios (HR) after IPAA were calculated from Cox proportional hazards regression analysis.
Fracture risk after IPAA was significantly reduced (adjusted HR = 0.49, 95% CI: 0.43; 0.55, p<0.001). Prior fractures and alcoholism independently increased fracture risk significantly. Osteoporotic fracture risk after IPAA was reduced, significantly for wrist fractures (aHR = 0.39, 95% CI: 0.22; 0.71, p = 0.002), and borderline insignificantly for spine fractures (aHR = 0.51, 95% CI: 0.26; 1.01, p = 0.054). Vitamin D and calcium levels were significantly higher in the patient group (61.2 nmol/L vs. 58.9 nmol/L, p = 0.04 and 1.24 mmol/L vs. 1.21 mmol/L, p<0.01, respectively), while parathyroid hormone and phosphate levels were significantly lower (4.9 pmol/L vs. 6.2 pmol/L, p<0.01 and 1.08 mmol/L vs. 1.12 mmol/L, p<0.01, respectively).
Fracture risk after IPAA is significantly reduced compared to the general population. Prospective studies are needed to verify the biochemical results.
回肠贮袋肛管吻合术（IPAA）是溃疡性结肠炎（UC）的首选手术治疗方法。对于该手术如何影响骨代谢和骨折风险知之甚少。本回顾性队列研究的目的是在丹麦 UC 患者的全国队列中研究 IPAA 后骨折风险和骨代谢血清标志物。
从全国患者登记处获得 1757 名患者和 8785 名对照的诊断代码，同时从区域数据库中收集血液结果。通过 Kaplan-Meier 图评估术后无骨折生存情况。使用 Cox 比例风险回归分析计算 IPAA 后的骨折危险比（HR）。
IPAA 后骨折风险显著降低（调整后的 HR = 0.49，95%CI：0.43；0.55，p<0.001）。既往骨折和酗酒独立显著增加骨折风险。IPAA 后骨质疏松性骨折风险降低，腕部骨折显著降低（aHR = 0.39，95%CI：0.22；0.71，p = 0.002），脊柱骨折则接近显著降低（aHR = 0.51，95%CI：0.26；1.01，p = 0.054）。与对照组相比，患者组的维生素 D 和钙水平明显更高（61.2 nmol/L 比 58.9 nmol/L，p = 0.04 和 1.24 mmol/L 比 1.21 mmol/L，p<0.01），而甲状旁腺激素和磷酸盐水平明显更低（4.9 pmol/L 比 6.2 pmol/L，p<0.01 和 1.08 mmol/L 比 1.12 mmol/L，p<0.01）。
与普通人群相比，IPAA 后的骨折风险显著降低。需要前瞻性研究来验证这些生化结果。
