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World J Gastrointest Pathophysiol. Nov 15, 2015; 6(4): 210-218
Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.210
Risk factors for osteoporosis in inflammatory bowel disease patients
Carla Andrade Lima, Andre Castro Lyra, Raquel Rocha, Genoile Oliveira Santana
Carla Andrade Lima, Pos-graduation program in medicine and health, Federal University of Bahia, Salvador, Bahia 40110-060, Brazil
Andre Castro Lyra, Genoile Oliveira Santana, Department of Gastroenterology, Federal University of Bahia, Salvador, Bahia 40110-060, Brazil
Raquel Rocha, Department of Sciences of Nutrition, School of Nutrition, Federal University of Bahia, Salvador, Bahia 40110-060, Brazil
Author contributions: Lima CA performed most of the writing and prepared the table; Lyra AC coordinated the writing of the paper; Rocha R coordinated the writing of the paper; Santana GO designed the outline and coordinated the writing of the paper.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or coauthors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Raquel Rocha, DMSc, Department of Science of Nutrition, School of Nutrition, Federal University of Bahia, Salvador, Araujo Pinho Avenue, number 32, Bahia 40110-060, Brazil. raquelrocha2@yahoo.com.br
Telephone: +55-71-99749964
Received: April 18, 2015
Peer-review started: April 18, 2015
First decision: June 18, 2015
Revised: August 22, 2015
Accepted: September 16, 2015
Article in press: September 18, 2015
Published online: November 15, 2015
Processing time: 213 Days and 11.6 Hours
Abstract

Inflammatory bowel disease (IBD) patients exhibit higher risk for bone loss than the general population. The chronic inflammation causes a reduction in bone mineral density (BMD), which leads to osteopenia and osteoporosis. This article reviewed each risk factor for osteoporosis in IBD patients. Inflammation is one of the factors that contribute to osteoporosis in IBD patients, and the main system that is involved in bone loss is likely RANK/RANKL/osteoprotegerin. Smoking is a risk factor for bone loss and fractures, and many mechanisms have been proposed to explain this loss. Body composition also interferes in bone metabolism and increasing muscle mass may positively affect BMD. IBD patients frequently use corticosteroids, which stimulates osteoclastogenesis. IBD patients are also associated with vitamin D deficiency, which contributes to bone loss. However, infliximab therapy is associated with improvements in bone metabolism, but it is not clear whether the effects are because of inflammation improvement or infliximab use. Ulcerative colitis patients with proctocolectomy and ileal pouches and Crohn’s disease patients with ostomy are also at risk for bone loss, and these patients should be closely monitored.

Keywords: Bone mineral density; Crohn’s disease; Osteoporosis; Ulcerative colitis; Inflammatory bowel disease; Risk factors

Core tip: Inflammatory bowel disease (IBD) is associated with bone loss. Some factors reduce bone mineral density and lead to osteopenia and osteoporosis. The major complication in osteoporosis is the increased risk of fracture, which may impact quality of life. This article reviews each risk factor for osteoporosis in IBD patients, like chronic inflammation, smoking, body composition, corticosteroid use, vitamin D deficiency, surgery, and the effect of infliximab therapy.