Risk factors for osteoporosis in inflammatory bowel disease patients

Abstract

Inflammatory bowel disease (IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density (BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn’s disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored.

Keywords: Bone mineral density; Crohn’s disease; Osteoporosis; Ulcerative colitis; Inflammatory bowel disease; Risk factors

Core tip: Inflammatory bowel disease (IBD) is associated with bone loss. Some factors reduce bone mineral density and lead to osteopenia and osteoporosis. The major complication in osteoporosis is the increased risk of fracture, which may impact quality of life. This article reviews each risk factor for osteoporosis in IBD patients, like chronic inflammation, smoking, body composition, corticosteroid use, vitamin D deficiency, surgery, and the effect of infliximab therapy.