Miznerova E, Hlavaty T, Koller T, Toth J, Holociova K, Huorka M, Killinger Z, Payer J
Department of Internal Medicine, Comenius University, Bratislava Ruzinov, Slovakia.
Bratisl Lek Listy. 2013;114(8):439-45. doi: 10.4149/bll_2013_092.
Osteoporosis is a known chronic complication of inflammatory bowel diseases (IBD). The aim of our study was to describe the prevalence of reduced bone mineral density (BMD) in IBD patients and to identify crucial risk factors for osteoporosis.
The cohort consisted of 76 IBD patients, 40 with Crohn's disease (CD) and 36 with ulcerative colitis (UC). Clinical characteristics of every patient were recorded, i.e. age, sex, duration of the disease, clinical behavior, location of disease according to Montreal classification, surgeries, steroid medication, sIBDQ, and smoking habits. We examined the serum 25-hydroxyl vitamin D3 (25-OHD3) in each patient. The BMD was determined by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral neck.
Osteoporosis was documented in 10 IBD patients (13.2 %), while osteopenia in 35 of them (46.1 %). Patients with CD have significantly lower femoral Z score than patients with UC. Femoral Z score was strongly associated with disease duration, and in CD patients suffering from stricturing form, with ileic or ileocolic location and history of proctocolectomy or total colectomy. Patients with osteoporosis had a significantly lower level of 25-OHD3 than patients with normal BMD.
Patients with long disease duration and those suffering from stricturing form of CD with ileic/ileocolic location and history of proctocolectomy/total colectomy are at higher risk of developing osteoporosis than other IBD patients. The high proportion of osteopenia/osteoporosis in our study underlines the importance of BMD measurement in all IBD patients as a base for initiating the appropriate treatment (Tab. 1, Fig. 3, Ref. 63).
骨质疏松是炎症性肠病（IBD）已知的慢性并发症。本研究的目的是描述IBD患者骨密度（BMD）降低的患病率，并确定骨质疏松的关键危险因素。
该队列由76例IBD患者组成，其中40例为克罗恩病（CD），36例为溃疡性结肠炎（UC）。记录每位患者的临床特征，即年龄、性别、病程、临床行为、根据蒙特利尔分类法的病变部位、手术情况、类固醇药物使用情况、简化IBD问卷（sIBDQ）和吸烟习惯。检测每位患者的血清25-羟基维生素D3（25-OHD3）。通过双能X线吸收法（DXA）测定腰椎和股骨颈的骨密度。
10例IBD患者（13.2%）被诊断为骨质疏松，35例（46.1%）为骨量减少。CD患者的股骨Z值显著低于UC患者。股骨Z值与病程密切相关，在患有狭窄型CD的患者中，与回肠或回结肠病变部位以及直肠结肠切除术或全结肠切除术史有关。骨质疏松患者的25-OHD3水平显著低于骨密度正常的患者。
病程长的患者以及患有狭窄型CD且病变位于回肠/回结肠、有直肠结肠切除术/全结肠切除术史的患者比其他IBD患者发生骨质疏松的风险更高。我们研究中骨量减少/骨质疏松的高比例强调了对所有IBD患者进行骨密度测量以作为启动适当治疗依据的重要性（表1，图3，参考文献63）。
