A new study shows that many people newly diagnosed with inflammatory bowel disease also have osteoporosis or osteopenia (reduced bone density). A researcher says that the prevalence seems to be especially high among postmenopausal women and men older than 50 years.
People diagnosed with an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis might benefit from having their bone health examined. A new study shows that many people newly diagnosed with inflammatory bowel disease have either osteoporosis or osteopenia, especially postmenopausal women and men older than 50 years.
According to a researcher behind the study, the discovery is clinically relevant because people with inflammatory bowel disease frequently take steroids, which can break down bone.
Treatment for one disease may therefore possibly worsen the other.
“The problem may be that people with bowel diseases are treated with quite large doses of steroids, even higher than for inflammatory skin diseases or rheumatoid arthritis. In addition, people with inflammatory bowel diseases are not routinely examined for osteoporosis, although they should be according to the guidelines for endocrine diseases and disorders. This study indicates a need to screen certain groups of people with inflammatory bowel diseases for osteoporosis,” explains Johan Burisch, Professor and Chief Physician, Gastro Unit, Amager and Hvidovre Hospital, Hvidovre, Denmark.
The research has been published in Inflammatory Bowel Diseases.
Investigated bone health among 350 people with inflammatory bowel disease
The study is part of a larger study in which the researchers aim to characterise the associations between inflammatory bowel diseases and other diseases.
The researchers found that many people with inflammatory bowel diseases have rheumatoid arthritis at the time of diagnosis. The same applies to the inflammatory skin disease hidradenitis suppurativa.
The researchers specifically investigated the prevalence of osteoporosis and osteopenia among people newly diagnosed with inflammatory bowel disease.
They therefore collected data on 1.2 million people living in the Capital Region of Denmark, 20% of Denmark‘s population, from May 2021 to May 2023.
Of these, 209 people were diagnosed with ulcerative colitis during the study period and 141 with Crohn’s disease.
Ulcerative colitis is a chronic intestinal disorder with an inflammatory reaction in the mucosa of the large intestine. The inflamed mucosa swells, becomes ulcerated and bleeds.
Crohn’s disease also features inflammation in the gut. Typical symptoms are prolonged diarrhoea, abdominal pain and sometimes weight loss.
The researchers examined all 350 people with inflammatory bowel disease for osteoporosis or osteopenia.
“We did not previously have figures for this, but this is very important to think about when we give steroids to people with inflammatory bowel disease, since these drugs can exacerbate osteoporosis and osteopenia,” notes Johan Burisch.
Surprisingly many had impaired bone health
Many of the participants with inflammatory bowel disease had osteoporosis or osteopenia at diagnosis.
Among women older than 52 years with ulcerative colitis, 35.7% had osteoporosis and 40.5% had osteopenia. The corresponding figures were 28.6% and 38.1% for women older than 52 years with Crohn’s disease,.
Among men older than 50 years with ulcerative colitis, 13.2% had osteoporosis and 44.7% osteopenia. The corresponding figures were 12.5% and 50% for men older than 50 years with Crohn’s disease.
Men and women younger than 50 years had much lower figures.
“This affects relatively many people in the context of an unrecognised bone disease or a risk factor for developing it later. The numbers are interesting because the steroids we prescribe may contribute to worsening their bone health if we are not careful,” says Johan Burisch.
Screening should be standard
Johan Burisch says that the study is the first of its kind to examine osteoporosis and osteopenia at the time of diagnosis of inflammatory bowel disease.
Previous studies examined the association at a later stage of the disease or among only the most severely ill people. The new study includes everyone newly diagnosed with inflammatory bowel disease.
The study also shows that osteoporosis or osteopenia was not limited to the people with the most severe inflammatory bowel disease.
“Our results indicate that gastroenterologists examining a postmenopausal woman or a man older than 50 years recently diagnosed with inflammatory bowel disease should request screening for bone health. This will not change the treatment for the bowel disease, but the person may also need treatment for the bone disease, and that can start early,” explains Johan Burisch, who adds that the researchers will now follow this cohort and monitor how their bone health progresses over time.
This may help to identify any groups that may need more additional monitoring.
“We should also focus on determining what to do with these people once they have been screened,” concludes Johan Burisch.
