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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Updated bone mineral density status in Saudi patients with inflammatory bowel disease
Mohammed Ewid, Nawaf Al Mutiri, Khalid Al Omar, Amal N Shamsan, Awais A Rathore, Nazmus Saquib, Anas Salaas, Omar Al Sarraj, Yaman Nasri, Ahmed Attal, Abdulrahman Tawfiq, Hossam Sherif
Mohammed Ewid, Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Mohammed Ewid, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Nawaf Al Mutiri, Khalid Al Omar, Amal N Shamsan, Awais A Rathore, Gastroenterology Department, King Fahad Specialist Hospital, Buraidah 52366, Al-Qassim, Saudi Arabia
Nazmus Saquib, Epidemiology Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Anas Salaas, Omar Al Sarraj, Yaman Nasri, Ahmed Attal, Abdulrahman Tawfiq, Medical students, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Hossam Sherif, Critical Care Medicine Department, College of Medicine, Sulaiman Al Rajhi University, Bukairyah 51941, Al-Qassim, Saudi Arabia
Hossam Sherif, Critical Care Medicine Department, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Ewid M, Al Mutiri N, Saquib N, and Sherif H conceived of the idea, developed the theory; Ewid M was the principle investigator; all author contributed towards methodology and towards the writing of the paper, and have read and approved the final manuscript.
Supported by Sulaiman Al Rajhi University, Saudi Arabia, from the Annual Budget of their Research Unit.
Institutional review board statement: The study received ethical approval from the Regional Research Ethics Committee-Qassim province, Ministry of Health, Saudi Arabia (approval number 20180102).
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohammed Ewid, MD, Assistant Professor, Internal Medicine Department, College of Medicine, Sulaiman Al Rajhi University, PO Box 777, Bukairyah 51941, Al-Qassim, Saudi Arabia. drmohammedowid@yahoo.com
Received: May 8, 2020
Peer-review started: May 8, 2020
First decision: June 8, 2020
Revised: June 15, 2020
Accepted: August 22, 2020
Article in press: August 22, 2020
Published online: September 21, 2020
BACKGROUND
Little is known about inflammatory bowel disease (IBD) burden and its impact on bone mineral density (BMD) among adult patients in Saudi Arabia. To the best of our knowledge, our study is the only study to give an update about this health problem in adult Saudi patients with IBD. IBD is a great risk factor for reduced BMD due to its associated chronic inflammation, malabsorption, weight loss and medication side effects. Consequently, screening for reduced BMD among patients with IBD is of utmost importance to curb and control anticipated morbidity and mortality among those patients.
AIM
To assess the relationship between IBD and BMD in a sample of adult Saudi patients with IBD.
METHODS
Ninety adult patients with IBD - 62 Crohn’s disease (CD) and 28 ulcerative colitis (UC) - were recruited from King Fahad Specialist Hospital gastroenterology clinics in Buraidah, Al-Qassim. All enrolled patients were interviewed for their demographic information and for IBD- and BMD-related clinical data. All patients had the necessary laboratory markers and dual-energy x-ray absorptiometry scans to evaluate their BMD status. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD.
RESULTS
The CD group was significantly more prone to osteopenia and osteoporosis compared to the UC group; 44% of the CD patients had normal BMD, 19% had osteopenia, and 37% had osteoporosis, while 78% of the UC patients had normal BMD, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), lumbar z-score (r = 0.77, P < 0.05) and femur z-score (r = 0.85, P < 0.05). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05). The ROC-curve showed that low BMI could predict the lowest t-score in the CD group with the best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59–0.84), with a sensitivity of 77%, and a specificity of 63%.
CONCLUSION
Saudi patients with IBD still have an increased risk of reduced BMD, more in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.
Core Tip: Saudi patients with inflammatory bowel disease still have a high prevalence of reduced bone mineral density. Osteopenia and osteoporosis burdens were 19% and 37% in Crohn’s disease (CD) patients, and 7% and 25% in ulcerative colitis patients, respectively. Low body mass index is a significant risk factor for reduced bone mineral density in CD patients.
