Low bone mineral density, osteoporosis, and osteopenia are known risk factors for both male and female patients with gut disorders and IBD. The Crohn’s and Colitis Foundation of America reports that 30 to 60 percent of people with IBD may have low bone density, which puts them at significant risk for osteoporosis. Lack of awareness leads to a situation where many patients who should be tested are not being referred to diagnostic tests, and therefore are not receiving therapy to reduce fracture risk. It is important for physicians to understand the magnitude of this risk and to refer patients to DEXA tests (dual-energy x-ray absorptiometry) for timely diagnosis.
Osteoporosis Risk factors that are specific to gut disorders and IBD include:
- Steroid use
- Extensive small bowel resection
- Vitamin D deficiency
- Excess of pro-inflammatory cytokines
Currently there is no way to reverse bone loss, so it is important to take preventive measures and to reduce the controllable risk factors that contribute to bone loss:
- Doctors can reduce the use of steroid (EEN is an effective alternative to steroids)
- Doctors can use steroid-sparing drugs such as azathioprine, 6-MP, methotrexate, infliximab, or budesonide—a systemic corticosteroid with fewer side effects than traditional steroids.
Be aware of medications that are prescribed to enhance bone health, which include the once-a-week bisphosphonate drugs approved for steroid-induced osteoporosis. Current research suggests that some of these medications end up creating hard but brittle bones.
Ask your doctor about osteoporosis screening, and learn all you can about prevention and safe treatment options. The most helpful book we found is Dr. Lani's No-Nonsense Bone Health Guide: The Truth About Density Testing Osteoporosis Drugs, and Building Bone Quality at Any Age, Dr. Simpson is a Chiropractic doctor and a Certified Clinical (bone) Densitometrist (CCD). In her book, she covers the topic of Osteoporosis and Digestive Disorders - diagnosis and alternative treatments. Dr. Simpson also shares advice about proper diet and exercise to help prevent and manage osteoporosis. Her web site can be found at http://www.lanisimpson.com/
Research on IBD and osteoporosis
- What People With Inflammatory Bowel Disease Need to Know About Osteoporosis
- Osteoporosis in inflammatory bowel disease (Science Direct 2008)
- Osteoporosis in Inflammatory Bowel Disease (American Journal of Medicine 2009)
- Undiagnosed Gluten and wheat sensitivity appears to be a major cause of bone loss
- Osteoporosis and Steroid Medications