Predictive factors causing bone loss in inflammatory bowel disease

Inflammatory bowel disease is a chronic recurrent inflammatory pathology of the gastrointestinal tract, which is associated with intestinal involvement and extraintestinal manifestations. Extra-intestinal findings (also called complication) may sometimes be the first sign or complaint, but sometimes cause more severe morbidity than the underlying intestinal disorder. One of the problems in inflammatory bowel disease is bone mineral disease, osteoporosis and osteomalacia. Osteoporosis is more common than osteomalacia. The aim of this study was to determine the predictive factors leading to bone loss in inflammatory bowel disease and the prevalence of osteoporosis in inflammatory bowel disease. A total of 97 patients who had bone mineral density measurement at any time were included in the study, January 2014 to December 2018, Akdeniz University, Faculty of Medicine, Department of Internal Medicine-Gastroenterology. The data of all patients who met the inclusion criteria (age 18, measured bone mineral density and diagnosed as inflammatory bowel disease) were included in the study. In the measurement of bone mineral density, DEXA method was evaluated according to WHO and ECCO recommendations and 3 dependent variable groups were formed as normal, osteopenia and osteoporosis. Inflammatory bowel disease subgroup of ulcerative colitis and crohn's disease status, age, patient's gender, whether active smoking consumption, patient's decreased physical activity, disease activation score, duration of corticosteroid (mg) and dose (mg), acute phase reactant ESR (mm / hr), CRP (mg / dl) were studied as independent variables. In the study, data entry and evaluation was done by using Statistical Computer Package Program (SPSS 20.0). The comparison of the groups in the structured analyzes compare with the chi square, the man whitney u and the krusker walls. P value obtained from the analyzes was considered as statistically significant since it was less than 0.05. 27 (27.8%) of the patients were male and 70 (72.2%) were female. When the patients included in the study were evaluated according to the Inflammatory Bowel Disease group, the number of cases diagnosed as ulcerative colitis was 63 (64.9%) and the number of cases diagnosed as Crohn's disease was 34 (35.1%). According to DEXA results of 97 patients included in the study, 13 (13.4%) patients with normal bone mineral density and 44 (45.4%) with osteopenia and 40 (41.2%) with osteoporosis were determined. In our study, no statistically significant difference was found between ulcerative colitis and crohn's disease in terms of normal bone density, osteopenia and osteoporosis (p> 0.05). According to gender, there was no statistically significant difference according to normal bone density, osteopenia and osteoporosis (p> 0.05). A statistically significant relationship was found between osteoporosis and the degree of activation of inflammatory disease (p <0.001).The mean age of the participants with osteoporosis was found to be significantly higher than the patients with normal DEXA (p = 0.011). Participants with osteoporosis as a result of DEXA, the duration of smoking was found to be statistically higher than those with osteopenia and normal DEXA results (p =0.009). There was no statistically significant relationship between DEXA and body mass index (p> 0.05). According to the DEXA results, the sedimentation value (p = 0.011) and the crp level (p = 0.026) were found to be significantly higher in patients with osteoporosis than those with normal DEXA. In the study, osteopenia was found to be significantly higher in patients with osteoporosis than DEXA and the duration of corticosteroid use was significantly higher than normal ones (p <0.001). The participants who had osteoporosis as a result of DEXA were found to have statistically higher corticosteroid dose (mg) than osteopenia and normal DEXA results (p <0.001). Osteoporosis was found to be 5.04 times higher in the corticosteroid group and 5.79 times higher in the group with crp level ≥0.5mg. Osteoporosis is 29.39 times higher in patients with reduced physical activity than those with normal physical activity. The degree of osteoporosis disease is 12.75 times higher in patients with moderate / severe disease, 1.42 times higher in smokers. In conclusion, the predictive factors affecting osteoporosis which may develop as a complication of in inflammatory bowel disease have been demonstrated in our study. Osteoporosis is an important cause of morbidity and mortality in IBD. To define the osteoporosis with the appropriate method in the risky patients and to define the predictive factors that will affect osteoporosis, should be reduced to a minimum, correctable-preventable predictive factors and these patients should be treated with appropriate treatment algorithms for osteoporosis.