Department of Rheumatology, Lapeyronie Hospital and University of Montpellier, Montpellier, France.
Department of Rheumatology, Lapeyronie Hospital and EA2415, University of Montpellier, Montpellier, France.
Osteoporos Int. 2018 Nov;29(11):2389-2397. doi: 10.1007/s00198-018-4586-6. Epub 2018 Jun 16.
Inflammatory bowel diseases (IBDs) are associated with a decreased bone mineral density, but the impact on fractures is unknown. In our study, global risk of fracture is increased for patients with IBDs versus controls. This result will help to determine the appropriate assessment with early screening and management of osteoporosis. Inflammatory bowel diseases (IBDs), such as Crohn's disease (CD) and ulcerative colitis (UC), are associated with a decreased bone mineral density (BMD). However, the impact on fracture risk is unknown and data are contradictory across studies. In this systematic review and meta-analysis, we aimed to assess the risk of fracture and presence of low BMD in patients with IBDs compared to healthy controls. A systematic search of literature was conducted of MEDLINE, EMBASE, the Cochrane library and abstracts from appropriate scientific congresses. Studies were selected if they compared the incidence of fractures and/or BMD measurement by dual-energy X-ray absorptiometry in patients with IBDs and healthy sex- and age-matched controls. Data were extracted by two independent investigators. Meta-analysis was performed with the inverse variance approach to estimate pooled odds ratios (ORs) and risk ratios (RRs) with their 95% confidence intervals (CIs). Twenty-four studies met the inclusion criteria. On the basis of nine studies, global risk of fracture was increased for patients with IBDs versus controls (RR = 1.38, 95% CI 1.11-1.73; p = 0.005). Fracture risk with IBDs was significantly increased for vertebral fractures (OR = 2.26, 95% CI 1.04-4.90; p < 0.001), but not for any other site. The analysis of 16 studies evaluating BMD showed a significant decrease in mean BMD and Z-scores for IBD patients versus controls at all sites. In our meta-analysis, patients with IBDs have an increased risk of fractures, especially in the spine, and significant decreased BMD at all sites, which suggests the need for identifying high-risk individuals among this population.
炎症性肠病（IBD）与骨密度降低有关，但骨折的影响尚不清楚。在我们的研究中，与对照组相比，IBD 患者的骨折总体风险增加。这一结果将有助于确定适当的评估方法，包括早期筛查和骨质疏松症的管理。炎症性肠病（IBD），如克罗恩病（CD）和溃疡性结肠炎（UC），与骨密度（BMD）降低有关。然而，骨折风险的影响尚不清楚，并且研究结果相互矛盾。在这项系统评价和荟萃分析中，我们旨在评估与健康对照组相比，IBD 患者骨折风险和低 BMD 的存在情况。我们对 MEDLINE、EMBASE、Cochrane 图书馆和相关科学大会摘要进行了系统文献检索。如果研究比较了 IBD 患者和性别、年龄匹配的健康对照组的骨折发生率和/或双能 X 线吸收法测量的 BMD，则选择这些研究。数据由两名独立研究人员提取。使用逆方差法进行荟萃分析，以估计汇总优势比（OR）和风险比（RR）及其 95%置信区间（CI）。有 24 项研究符合纳入标准。基于 9 项研究，与对照组相比，IBD 患者的总体骨折风险增加（RR=1.38，95%CI 1.11-1.73；p=0.005）。IBD 患者的骨折风险显著增加，尤其是椎体骨折（OR=2.26，95%CI 1.04-4.90；p<0.001），但其他部位无此风险。对 16 项评估 BMD 的研究进行的分析表明，与对照组相比，IBD 患者在所有部位的平均 BMD 和 Z 评分均显著降低。在我们的荟萃分析中，IBD 患者骨折风险增加，尤其是脊柱骨折，所有部位的 BMD 均显著降低，这表明需要在该人群中识别高危个体。
