Managing osteoporosis in ulcerative colitis: Something new?

Table 1 Montreal classification of extent and severity of ulcerative colitis

Extent	Anatomy	Severity	Definition
E1: Ulcerative proctitis	Limited to the rectum	S0: Clinical remission	Asymptomatic
E2: Left sided (distal) ulcerative colitis	Limited to a proportion of the colorectum distal to the splenic flexure	S1: Mild	≤ 4 stools/d (with or without blood), absence of systemic illness, and normal inflammatory markers
E3: Extensive (pancolitis) ulcerative colitis	Extends proximally to the splenic flexure	S2: Moderate	> 4 stools/d but minimal signs of systemic toxicity
		S3: Severe	≥ 6 bloody stools/day, pulse ≥ 90 beats/min, temperature ≥ 37.5 °C, haemoglobin < 1.05 g/L, and erythrocyte sedimentation rate ≥ 30 mm in the first hour

Adapted from: Ford et al[1].

Table 2 Effect on vertebral fracture rates (from randomized controlled trials)

	Osteopenia	Osteoporosis	Established
Raloxifene	●	■	■
Alendronate	NA	■	■
Risedronate	NA	●	■
Ibandronate	NA	■	■
Zoledronate	NA	■	■
Teriparatide	NA	NA	■
Strontium ranelate	●	■	■
Denosumab	NA	■	■

■ Denotes a preplanned analysis in the entire study population; ●Denotes a post hoc analysis. NA: No evidence available. Adapted from: Body et al[12].

Table 3 Effect on nonvertebral/hip fracture rates (from randomized controlled trials)

	Nonvertebral		Hip
	Osteoporosis (without prevalent vertebral fractures)	Established osteoporosis (with prevalent vertebral fractures)	Osteoporosis (without prevalent vertebral fractures)	Established osteoporosis (with prevalent vertebral fractures)
Raloxifene	NA	●	NA	NA
Alendronate	■	■	NA	■
Risedronate	NA	■	NA	■
Ibandronate	NA	●	NA	NA
Zoledronate	■	NA	■	NA
Teriparatide	NA	■	NA	NA
Strontium Ranelate	●	■	●	▲
Denosumab	■	NA	■	NA

■ Denotes a preplanned analysis in the entire study population; ▲ Denotes a preplanned analysis on a subset of the study population; ● Denotes a post hoc analysis. NA: No evidence available. Adapted from: Body et al[12].