It is well known that patients with IBD are more likely to suffer from osteoporosis and osteopaenia (a less severe reduction in the density and strength of the bones). There has been long discussion as to whether this is caused by the IBD itself, or by its treatment. Corticosteroids such as prednisolone, for example, are well known to be an important cause of osteoporosis.
In 2001 Dr Keith Dear, now a consultant gastroenterologist in Chesterfield, but then undertaking research in our department, published a paper (Dear KLE, Compston JE, Hunter JO) Clinical Nutrition (2001) 20, 541-546) which showed that bone densities in patients with Crohn’s disease who had never received corticosteroids, because they were treated by diet or surgery, were no different from people who had never suffered from Crohn’s disease at all. Those treated by corticosteroids, by contrast, had significant reduction in their bone density, even when their age and sex were allowed for. This was, however, a relatively small study, involving only 95 patients in all.
I was very pleased therefore to read an important paper from Canada, published in the March 2013 edition of Clinical Gastroenterology and Hepatology, which confirmed Keith Dear’s findings. Every patient in Manitoba who has a bone density test is recorded on a central data base, and the researchers had as many as 45,714 records to consider. 1230 of these also had IBD – either ulcerative colitis and Crohn’s disease. The results were not strictly comparable to ours, as diet is apparently not amongst the therapeutic possibilities available to patients with Crohn’s disease in Manitoba. Nevertheless, although patients with Crohn’s disease were nearly 50% more likely to have osteoporosis than controls, careful statistical analysis of this massive quantity of data showed that IBD itself had very little effect on bone density. Crohn’s posed a greater risk than ulcerative colitis, but it was a very small effect and the risk of osteoporosis associated with IBD was related to factors well known to increase the risk – including age, sex and, of course, corticosteroids. (Targownik LE, Bernstein CN Nugent Z and Leslie WD Clinical Gastroenterology and Hepatology, 2013,11:278-285)
The moral of the story – if your Crohn’s can be controlled by diet, then so much the better!
This article was first published on the original crohns.org.uk blog. Research has moved on since, so please check current advice with your IBD team.