Schüle Solvey, Rossel Jean-Benoît, Frey Diana, Biedermann Luc, Scharl Michael, Zeitz Jonas, Freitas-Queiroz Natália, Kuntzen Thomas, Greuter Thomas, Vavricka Stephan R, Rogler Gerhard, Misselwitz Benjamin
Division of Gastroenterology and Hepatology, University Hospital Zurich and University of Zurich, Zurich Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne Division of Rheumatology, University Hospital Zurich and University of Zurich Department of Medicine, Division of Gastroenterology, Triemli Hospital, Zurich, Switzerland.
Medicine (Baltimore). 2017 Jun;96(22):e6788. doi: 10.1097/MD.0000000000006788.
Low bone mineral density (BMD) and osteoporosis remain frequent problems in patients with inflammatory bowel diseases (IBDs). Several guidelines with nonidentical recommendations exist and there is no general agreement regarding the optimal approach for osteoporosis screening in IBD patients. Clinical practice of osteoporosis screening and treatment remains insufficiently investigated.In the year 2014, a chart review of 877 patients included in the Swiss IBD Cohort study was performed to assess details of osteoporosis diagnostics and treatment. BMD measurements, osteoporosis treatment, and IBD medication were recorded.Our chart review revealed 253 dual-energy x-ray absorptiometry (DXA) scans in 877 IBD patients; osteoporosis was prevalent in 20% of tested patients. We identified widely differing osteoporosis screening rates among centers (11%-62%). A multivariate logistic regression analysis identified predictive factors for screening including steroid usage, long disease duration, and perianal disease; even after correction for all risk factors, the study center remained a strong independent predictor (odds ratio 2.3-21 compared to the center with the lowest screening rate). Treatment rates for patients with osteoporosis were suboptimal (55% for calcium, 65% for vitamin D) at the time of chart review. Similarly, a significant fraction of patients with current steroid medication were not treated with vitamin D or calcium (treatment rates 53% for calcium, 58% for vitamin D). For only 29% of patients with osteoporosis bisphosphonate treatment was started. Treatment rates also differed among centers, generally following screening rates. In patients with longitudinal DXA scans, calcium and vitamin D usage was significantly associated with improvement of BMD over time.Our analysis identified inconsistent usage of osteoporosis screening and underuse of osteoporosis treatment in IBD patients. Increasing awareness of osteoporosis as a significant clinical problem in IBD patients might improve patient care.
低骨矿物质密度（BMD）和骨质疏松症仍是炎症性肠病（IBD）患者中常见的问题。现有多项建议不尽相同的指南，对于IBD患者骨质疏松症筛查的最佳方法尚无普遍共识。骨质疏松症筛查和治疗的临床实践仍未得到充分研究。2014年，对纳入瑞士IBD队列研究的877例患者进行了病历审查，以评估骨质疏松症诊断和治疗的详细情况。记录了BMD测量值、骨质疏松症治疗情况和IBD用药情况。我们的病历审查显示，877例IBD患者中有253例进行了双能X线吸收测定（DXA）扫描；20%的受检患者患有骨质疏松症。我们发现各中心的骨质疏松症筛查率差异很大（11%-62%）。多因素逻辑回归分析确定了筛查的预测因素，包括使用类固醇、病程长和肛周疾病；即使校正了所有风险因素后，研究中心仍是一个强有力的独立预测因素（与筛查率最低的中心相比，优势比为2.3-21）。在病历审查时，骨质疏松症患者的治疗率并不理想（钙治疗率为55%，维生素D治疗率为65%）。同样，相当一部分正在使用类固醇药物的患者未接受维生素D或钙治疗（钙治疗率为53%，维生素D治疗率为58%）。只有29%的骨质疏松症患者开始使用双膦酸盐治疗。各中心的治疗率也有所不同，总体上与筛查率一致。在进行纵向DXA扫描的患者中，钙和维生素D的使用与BMD随时间的改善显著相关。我们的分析发现，IBD患者在骨质疏松症筛查方面存在使用不一致的情况，且骨质疏松症治疗的使用率不足。提高对骨质疏松症作为IBD患者重要临床问题的认识可能会改善患者护理。
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