THERAPIES AND BONE IMPAIRMENT IN INFLAMMATORY BOWEL DISEASE YOUNG ADULTS

Low bone mineral density (BMD) and fractures are well-known complications associated with inflammatory bowel disease (IBD). The most incriminated causes are the exposure to high doses of glucocorticoids, chronic inflammation, and malabsorption; however, the impact of biologic therapy on bones' mass is still under debate. The objective of this study was to evaluate the prevalence of low BMD and the impact of different therapies on bone impairment in IBD young patients. A total of 52 premenopausal women and men (under 50 years old) IBD patients and 53 healthy subjects (matched for age, gender, and body mass index (BMI) were included in this study. Dual energy X-ray assessment (DXA) was performed in all the subjects. DXA parameters of 38 well-controlled patients (of which 24 on biologic agents and 14 with previous exposure to high doses of glucocorticoids) were compared with those of healthy controls. Low BMD status was more prevalent in IBD patients when compared to healthy subjects (32.6% vs 9.4 %, chi = 8.5, p = 0.003). Lumbar spine BMD was significantly higher in healthy controls than in IBD patients on biologic therapies (1.2 +/- 0.11 vs 1.09 +/- 0.17, p = 0.002). Both lumbar spine and hip BMD were significantly lower in patients with previous exposure to long-term glucocorticoids when compared to controls (0.94 +/- 0.13 vs 1.22 +/- 0.11, p < 0.001; 0.85 +/- 0.11 vs 0.95 +/- 0.14, p = 0.04), and also when compared to patients on biologic agents (0.94 +/- 0.13 vs 1.09 +/- 0.17, p = 0.01; 0.85 +/- 0.11 vs 0.95 +/- 0.14, p = 0.04 respectively). Our study showed that low BMD is a frequent complication in young adults with IBD. Although long-term exposure to glucocorticoids has a deleterious impact on bone loss, this effect is also observed in patients on biologic therapy. Hence, an early diagnosis, as well as a long term follow-up, are required for these patients.