Published online Sep 21, 2020. doi: 10.3748/wjg.v26.i35.5343
Peer-review started: May 8, 2020
First decision: June 8, 2020
Revised: June 15, 2020
Accepted: August 22, 2020
Article in press: August 22, 2020
Published online: September 21, 2020
Processing time: 131 Days and 13.4 Hours
Inflammatory bowel disease (IBD) is showing an increasing trend in newly industrialized countries worldwide, including Saudi Arabia. Reduced bone mineral density (BMD) is a major documented extraintestinal complication in patients with IBD. As with other IBD patients, Saudi patients with IBD will have increased fracture risk and lower quality of life if not properly screened for reduced BMD.
Little is known about how much reduced BMD occurs among Saudi patients with IBD or about the predisposing factors in that population. Our study gives an update about reduced BMD among adult Saudi patients with IBD. We hope it will help health care providers curb the anticipated complications through proper preventive and screening measures.
We aimed to assess the current burden of reduced BMD and its possible risk factors among adult Saudi patients with IBD. Moreover, we investigated any possible variations between Crohn’s disease (CD) and ulcerative colitis (UC) patients, either in the disease burden or its related risk factors.
Ninety adult patients with IBD - 62 CD and 28 UC - were recruited from King Fahad Specialist Hospital gastroenterology clinics in the city of Buraidah, Saudi Arabia. Demographics, clinical workups and dual x-ray energy absorptiometry (DXA) scan data were obtained. Patients were divided into two groups (CD and UC) to explore their clinical characteristics and possible risk factors for reduced BMD. Appropriate statistical tests were used according to the variables. A P < 0.05 was considered significant.
Patients with CD were at higher risk for reduced BMD than those with UC; 19% of CD patients had osteopenia, and 37% had osteoporosis, while among the UC patients, 7% had osteopenia, and 25% had osteoporosis (P value < 0.05). In the CD group, the lowest t-score showed a statistically significant correlation with body mass index (BMI) (r = 0.45, P < 0.001), best cut-off value at ≤ 23.43 (m/kg2); area under the curve was 0.73 (95%CI: 0.59–0.84). In the UC group, the lowest t-score showed only statistically significant correlation with the lumbar z-score (r = 0.82, P < 0.05) and femur z-score (r = 0.80, P < 0.05).
There is still an increased risk of reduced BMD for Saudi patients with IBD, more so in CD patients. Low BMI is a significant risk factor for reduced BMD in CD patients.
We recommend further prospective multicenter studies among adult Saudi patients with IBD for a better assessment of reduced BMD risk factors and to investigate the current DXA screening practices among those patients.