Osteoporosis and Inflammatory Bowel Disease

What is Osteoporosis?

Osteoporosis is a condition resulting from loss of collagen and minerals (the components of bone) from bone causing them to become weak and thin and thus increasing the risk of fractures. 

What is the cause?

Research has shown that the major cause of osteoporosis in IBD is due to:

1. Long-term use of steroids, i.e. greater than 5gm over the course of time.
2. Disease activity – high dose steroids used to control active disease may not be the only contributing factor, rather the inflammation itself may play a part in the development of osteoporosis.
3. Absorption of Vitamin D and Calcium, necessary for the production of healthy bone, may be poor in IBD.
4. Prolonged ill-health may lead to lack of exercise, or, in young women, cessation of the menstrual periods.

What are the symptoms?

There is a tendency to fracture bones after minor falls or injuries, especially the hip or wrist. If present in the spine it may cause chronic back pain, loss of height and curvature of the spine (Dowager’s hump) 

How may it be detected?

Several investigations may be carried out to prove the diagnosis. These could include:

1. Plain X-ray – Bones will appear more transparent and ‘cotton wool-like’ due to loss of density.
2. Bone densitometry – A special X-ray examination looking at the mineral content of bone.
3. Bone biopsy – Sometimes, taking a small piece of bone, usually from the edge of the pelvis (iliac crest), may be necessary.

What is the treatment?

Osteoporosis is irreversible once it has started to occur, so the emphasis is on prevention rather than cure. Despite continuing research into the condition, no single remedy is effective in its treatment. It is imperative that bones be allowed to develop to their fullest potential during their growth period and steps are taken to minimise mineral loss once this process has finished.

1. Dietary measures
2. Exercise
3. Hormone replacement therapy (HRT)