Osteoporosis and IBD

Osteoporosis and IBD

It was once thought that only old, small, white women get osteoporosis. Medical professional now know this is not the case. Unfortunately, people who suffer from inflammatory bowel disease have a higer propensity than the average person to get osteoporosis. As if dealing with Crohn's disease or ulcerative colitis is not enough to worry about, patients now have to also gauge their bone density.

Osteoporosis affects 30%-60% of people with IBD, and is more common in people with Crohn's than Ulcerative colitis.

Why do people with IBD have an increased risk of Osteoporosis?

There are a number of factors that may increase the risk of osteoporosis in people with IBD:

Bad Genes: Crohn's and colitis are autoimmune diseases. In general, this means that the body's immune system is on over-drive, and the body ends up attacking itself, and many of its key functions. As a result, people who suffer from IBD may not only have problems in the digestive tract, but they may also exhibit systemic complications in the liver, skin, eyes, joints, and bones. Thus, Crohn's and Colitis sufferers may also have a higher propensity to osteoporosis for genetic reasons.

Depending on the individual or the nature of the IBD, people may find other seemingly un-related diseases in the body, such as bone or arthritic or skin conditions. This has been seen many times in people who suffer from autoimmune diseases which is what makes them so hard to understand.

Cytokines release when IBD is active: When the disease is active, people with IBD have a higher level of proteins called cytokines. The presence of these proteins increase the body's inflammatory response which may upset the process of bone cell regeneration- removing old bone and adding new.

Corticosteroid Therapy: Prednisone is often prescribed to those suffered acute flare ups as it has powerful anti-inflammatory properties. However, it can also lead to a decrease in calcium absorption in the intestines. Long term steroid use leads to a decrease in bone-forming cells and an increase in the cells that contribute to bone resorption. Duration, dose and frequency all play a role in how severe the bone loss is from steroid use.

Vitamin D deficiency Vitamin D is absorbed in the small intestine, commonly a part that is highly affected in people with Crohn's disease. This can be particularly true for people who have had bowel resection. Vitamin D builds healthy bones- it can be found in supplements, fortified foods and from 15 minutes of sun exposure a day.

Other risk factors for Osteoporosis

If one has IBD as well as some of the following risk factors, their chances of being at risk for osteoporosis are even higher:

• Low Body Mass Index (BMI) : Thin, petite women of caucasion descent tend to be at higher risk than other women or men.

• Age : Bone mass growth slows significantly with age. Women's risk increases after menopause when their body's stop creating estrogen.

• Drinking and smoking: Excessive alcohol consumption can leach the body of calcium, as can smoking cigarettes.

• Lack of exercise. People with sedentary life styles are at greater risk of developing the disease. Active muscles build stronger bones.

What can people with IBD do to minimize risk of osteoporosis?

The good news is, there are steps that anyone with IBD can take to help stem osteoporosis before it becomes a real danger:

1. Don't Smoke. (Smoking can contribute to flare ups in Crohn's)
2. Minimize alcohol consumption (bad for the gut anyway.)
3. Stay active. Even though it can be tiring to battle the symptoms of IBD, staying active and physically strong is essential.
4. Eat well! Eat a balanced diet rich in calcium and vitamin as much as these foods agree with the gut.
5. Take supplements. Supplement the diet with high quality calcium and Vitamin D pills/vitamins.
6. Get a Bone density scan and check to see if there are any early signs of contracting osteoporosis. If there are, check with your doctor or a specialist about possible drug options to help develop bone mass.

There are many great developments in this field and bone density loss can be slowed and bone density/strength can be gained!

References

• CCFA (Crohn's and Colitis foundation of America), Summer 2005 newsletter.
• Other sources cited in this article include: 'Practical Gastroenterology', October 2004.