Increase in bone mineral density in strictly treated Crohn's disease patients with concomitant calcium and vitamin D supplementation

Sjoerd F. Bakkera, , , Vincent K. Dikb, 1, , Birgit I. Wittec, 2, , Paul Lipsd, 3, , Jan C. Roose, 4, , Adriaan A. Van Bodegravena, 5
a Department of Gastroenterology and Hepatology, VU University Medical Centre, PO Box 7057, The Netherlands
b Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, PO Box 85500, The Netherlands
c Department of Epidemiology and Biostatistics, VU University Medical Centre, PO Box 7057, The Netherlands
d Department of Internal Medicine, VU University Medical Centre, PO Box 7057, The Netherlands
e Department of Radiology, VU University Medical Centre, PO Box 7057, The Netherlands
Received 27 February 2012. Revised 1 May 2012. Accepted 2 June 2012. Available online 27 June 2012.
Journal of Crohn's and Colitis

Abstract
Background and aims
Decreased bone mineral density (BMD) is common in Crohn's disease (CD) patients. This paper reports on the prevalence of decreased BMD in a referral cohort study of CD-patients next to the change of BMD over time in relation with CD-associated clinical characteristics.

Methods
205 CD patients of a referral hospital were enrolled between januari 1998-January 2010 when measurement of BMD by dual X-ray absorptiometry (DXA) was available. Follow-up DXA scan was performed in subjects with known risk factors besides Crohn indicative for low BMD. Treatment of CD patients was according to a protocol which is comparable to the current (inter)national guidelines.
In osteopenic patients, supplemental vitamin D (800 IU) and Calcium (500–1000 mg) were prescribed.

Results
Mean BMD at baseline was 0.97 ± 0.16 gram/cm2 in lumbar spine and 0.87 ± 0.12 gram/cm2 in the total hip. At baseline, higher age and low Body Mass Index (BMI), were negatively correlated with BMD. Eighty-four patients underwent a second BMD assessment with a median interval period of 4 years (IQR 3–6). A mean annual increase of + 0.76% (95%CI: ? 2.63%; + 3.87%) in lumbar spine and + 0.43% (95%CI: ? 2.65% ; + 1.11%) in total hip was observed.

Conclusions
Higher age, male sex, low BMI, and a higher age at diagnosis of CD were associated with low BMD. Follow-up of BMD in CD patients showed a contraintuitive small increase of BMD at lumbar spine and total hip in CD patients only using supplemental vitamin D and calcium next to strict treatment of CD.
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