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30-05-2012 | Gastroenterology | Article

IBD sufferers at high risk for osteoporotic vertebral fracture


Free abstract

MedWire News: People with inflammatory bowel disease (IBD) are at increased risk for morphometric vertebral fractures, also known as low-impact or crush fractures, a case-control study has found.

The prevalence of such fractures was tripled in patients with Crohn's disease or ulcerative colitis compared with healthy individuals, highlighting the need for early preventive and therapeutic measures in IBD sufferers.

"Based on these results, we consider the early detection of morphometric fracture by X-ray to be very important regardless of clinical symptoms and bone mass," write Ma Angeles Vázquez (University of Seville, Spain) and co-authors in BMC Gastroenterology.

For their study, Vázquez and co-authors performed posteroanterior and lateral X-rays of the dorsal and lumbar spine (T4 to L4) in 107 patients with IBD and 51 healthy age-matched individuals.

Within the IBD cohort, the median age was 36.0 years, 53 had a diagnosis of Crohn's disease, and 54 had ulcerative colitis.

All X-rays were evaluated in a blinded fashion by two independent observers. Morphometric vertebral fractures were defined as a decrease of at least 20% (>4 mm) in any height measurement. Deformities and fractures due to nonosteoporotic causes were not considered.

In all, 72 such fractures were diagnosed in the IBD patients compared with 10 in healthy individuals, equating to significantly different rates of 38.32% and 13.73%.

Morphometric fractures were equally prevalent in the two forms of IBD but slightly more frequent in men than in women in both case and control groups, and occurred at a younger age in IBD patients compared with controls (36.75 vs 53.41 years).

Interestingly, neither bone mineral density nor corticosteroid treatment was associated with the risk for morphometric vertebral fracture; indeed, in multivariate analysis, a positive diagnosis of IBD was the only significant predictor, at an odds ratio of 4.03.

Finally, although mean vitamin D levels were similar between cases and controls, and between patients with and without fractures, hypovitaminosis D was highly prevalent in the IBD cohort, with 55.14% of patients having serum vitamin D levels below 30 ng/mL.

The researchers conclude: "From the studied parameters, having [IBD] was the only factor proven to be predictive of fracture, supporting the hypothesis of the important role played by proinflammatory cytokines on vertebral fractures and low bone mass."

By Joanna Lyford

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