Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
Deparment of Endocrinology, Copenhagen University Hospital Herlev, Herlev, Denmark.
J Crohns Colitis. 2020 Jul 30;14(7):904-914. doi: 10.1093/ecco-jcc/jjaa019.
Patients with inflammatory bowel disease [IBD] including Crohn's disease [CD] and ulcerative colitis [UC] are at risk of developing metabolic bone disease. The aims here were to investigate the screening strategy, incidence and risk factors of osteoporosis in a prospective population-based inception cohort.
Between 2003 and 2004 all incident patients diagnosed with CD and UC in a well-defined Copenhagen area were included and followed until 2015. Data were compared with a control population [at a ratio of 1:20]. Regression models were performed with several covariates. The sensitivity of the Danish registries for osteoporosis was also assessed.
A total of 513 patients were included [213 CD, 300 UC]. Overall, 338 (66%, CD: 164 [77%], UC: 174 [58%], p < 0.001] patients received ≥ 500 mg corticosteroid within a year, resulting in 781 patient-years at risk of osteoporosis. Of those, only 83 [10.6%] patient-years were followed by a dual-energy X-ray absorptiometry scan within the same or the following 2 years.Overall, 73 [14.2%] IBD patients (CD: 31 [14.6%], UC: 42 [14%]) and 680 [6.6%, p < 0.001] controls were diagnosed with osteoporosis during follow-up. The risk of osteoporosis was increased compared to the control population (odds ratio: CD: 2.9 [95% confidence interval: 2.0-4.1], UC: 2.8 [2.1-3.9]).
In this population-based inception cohort, the incidence of osteoporosis was significantly higher compared to a control population. Measurement of bone mineral density is infrequent, especially in patients at high risk of developing osteoporosis. These results demonstrate the need of further awareness of the risk of osteoporosis among IBD patients, and prospective population-based studies are warranted.
炎症性肠病（IBD）患者，包括克罗恩病（CD）和溃疡性结肠炎（UC），存在代谢性骨病的风险。本研究旨在调查一个基于人群的前瞻性发病队列中骨质疏松症的筛查策略、发生率和危险因素。
2003 年至 2004 年，在丹麦哥本哈根地区，所有新确诊的 CD 和 UC 患者均被纳入研究，并随访至 2015 年。通过与对照人群（1:20）进行比较，得出数据。通过回归模型，对多个协变量进行了分析。同时，还评估了丹麦登记处对骨质疏松症的敏感性。
共纳入 513 例患者（213 例 CD，300 例 UC）。总体而言，338 例（66%，CD：164 [77%]，UC：174 [58%]，p<0.001）患者在一年内接受了≥500 mg 皮质类固醇治疗，导致骨质疏松症风险患者年数为 781。其中，只有 83 例（10.6%）患者在同年内或随后 2 年内接受了双能 X 线吸收法骨密度扫描。在随访期间，73 例（14.2%）IBD 患者（CD：31 [14.6%]，UC：42 [14%]）和 680 例（6.6%，p<0.001）对照者被诊断为骨质疏松症。与对照人群相比，IBD 患者发生骨质疏松症的风险增加（CD：比值比 2.9 [95%置信区间：2.0-4.1]，UC：比值比 2.8 [2.1-3.9]）。
在本基于人群的发病队列中，骨质疏松症的发生率明显高于对照人群。骨密度的测量频率较低，尤其是在骨质疏松症高风险患者中。这些结果表明，需要进一步提高 IBD 患者对骨质疏松症风险的认识，有必要开展前瞻性的基于人群的研究。
