Casals-Seoane Fernando, Chaparro María, Maté José, Gisbert Javier P
Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
Inflamm Bowel Dis. 2016 Aug;22(8):1929-36. doi: 10.1097/MIB.0000000000000815.
The clinical course of bone mineral density (BMD) disorders and the efficacy of treatment of osteopenia and osteoporosis have been poorly studied in patients with inflammatory bowel disease (IBD). The objective was to study the course of BMD disorders in patients with IBD, analyze the factors influencing their development, and assess the effect of treatment with calcium, vitamin D, and bisphosphonates.
Consecutive patients with IBD were included and followed up for 5 years. After a baseline densitometry, calcium (1000 mg/d) and vitamin D (800 IU/d) were administered to patients with osteopenia; bisphosphonates to patients with osteoporosis; and patients with normal BMD were only followed-up. After completing the follow-up period, a second densitometry was performed.
One hundred patients were initially included, 60% having a low BMD (44% osteopenia and 16% osteoporosis). Fifty-eight patients completed the follow-up period. At baseline, osteopenia was more frequently found in Crohn's disease than in ulcerative colitis (63% versus 21%, P < 0.05). In patients with normal BMD at baseline, age, smoking habit, and the presence of flares during follow-up were associated with the development of osteopenia. Treatment with calcium and vitamin D improved the hip T-score in patients with osteopenia (-1.03 versus -0.58, P < 0.001) and bisphosphonates provided the same improvement (-1.482 versus -1.072, P < 0.05) in patients with osteoporosis.
Age, smoking habit, and IBD activity negatively influence the clinical course of BMD. Treatment with calcium and vitamin D improves hip T-score in patients with osteopenia whereas bisphosphonates improve hip T-score in patients with osteoporosis.
炎症性肠病（IBD）患者骨矿物质密度（BMD）紊乱的临床病程以及骨质减少和骨质疏松症的治疗效果研究较少。目的是研究IBD患者BMD紊乱的病程，分析影响其发展的因素，并评估钙、维生素D和双膦酸盐治疗的效果。
纳入连续的IBD患者并随访5年。在进行基线骨密度测定后，对骨质减少患者给予钙（1000mg/d）和维生素D（800IU/d）；对骨质疏松患者给予双膦酸盐；BMD正常的患者仅进行随访。随访期结束后，进行第二次骨密度测定。
最初纳入100例患者，60%的患者BMD较低（44%为骨质减少，16%为骨质疏松）。58例患者完成了随访期。基线时，克罗恩病患者比溃疡性结肠炎患者更常出现骨质减少（63%对21%，P<0.05）。基线时BMD正常的患者中，年龄、吸烟习惯和随访期间发作的存在与骨质减少的发生有关。钙和维生素D治疗改善了骨质减少患者的髋部T值（-1.03对-0.58，P<0.001），双膦酸盐在骨质疏松患者中也有相同的改善效果（-1.482对-1.072，P<0.05）。
年龄、吸烟习惯和IBD活动对BMD的临床病程有负面影响。钙和维生素D治疗可改善骨质减少患者的髋部T值，而双膦酸盐可改善骨质疏松患者的髋部T值。
