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|Title:||Osteoporosis in inflammatory bowel disease aetiology, diagnosis and treatment|
|Authors:||Robinson, Richard John.|
|Abstract:||In 117 (male = 48) patients with Crohn's disease (CD) aged 20 to 65 years, bone mineral density (BMD) and biochemical markers of bone turnover were measured. Sex hormone status was assessed in men with CD. Hand skinfold thickness and calcaneal ultrasound were evaluated as screening tools for osteoporosis; and the effect of low impact exercise on BMD was prospectively studied. In patients with colitis, the effects of rectal steroids on bone turnover was investigated.;The major determinants of BMD in CD were body weight, corticosteroids and male sex. Hypogonadism was an uncommon cause of flow BMD in men with CD. The bone resorption marker deoxypyridinoline was significantly increased in patients with CD compared to controls (10.97 (9.22) nMDPD/mMCreatinine vs 5.02 (1.03) mMDPH/mMCreatinine, difference in means-=5.95, 95% CI -9.6 to -2.3, p=0.00001) but bone formation markers were not significantly different. Hand skinfold thickness was significantly associated with BMD at the lumbar spine and femoral neck (r=0.43, 95% CI 0.27, 0.57 p<0.0001). However, the relation was inadequate to diagnose osteoporosis in an individual. Similarly, the sensitivity and specificity of calcaneal ultrasound were too low to recommend it as a screening tool for osteoporosis at the hip (sensitivity 66.7%, specificity 85.6%) or spine (sensitivity 75%, specificity 89%).;Significant gains in BMD occurred at the trochanter of patients who fully complied with a 12 month exercise programme (+7.7% (8.2) vs +3.1% (5.83), difference in means=4.67%, 95% CI 0.86 to 8.48, p=0.02). Increases in BMD were significantly related to compliance with the exercises and were independent of other potential confounding variables.;In patients with colitis, rectally administered corticosteroids had no significant effects on bone turnover.;Bone resorption is increased in patients with CD who are at high risk of low BMD. Corticosteroids are an important aetiological factor and rectally administered steroids should be prescribed wherever possible. Low impact exercise could be an effective method of increasing BMD in some patients with CD.|
|Rights:||Copyright © the author. All rights reserved.|
|Appears in Collections:||Theses, College of Medicine, Biological Sciences and Psychology|
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