Corticosteroid Use and Fracture Risk in People with Inflammatory Bowel Disease
1/13/2004
The rate of fracture among people with inflammatory bowel disease (IBD) is slightly higher than that of the general population, and researchers believe it is important to define high-risk groups worthy of diagnostic evaluation or prophylactic interventions. In other disease, corticosteroid use has been considered to be a risk for fracture. However, not all studies in IBD show the same results on this issue.
CN Bernstein and colleagues aimed to see whether people with IBD drawn from a population-based database who develop fractures are more likely to have been using corticosteroids than a matched group of IBD patients who did not experience a fracture.
Spondylitis (SpA) of IBD is one of the forms of spondyloarthritis. See "What is SpA of IBD". This condition involves both inflammation of the intestinal wall (IBD) and a chronic form of spinal arthritis (SpA). IBD can be broken down into two different diseases -- Crohn’s disease and ulcerative colitis.
Methods
They studied patients from the University of Manitoba Inflammatory Bowel Disease Epidemiology Database.
Results
Fractures were identified in 13 patients with Crohn’s disease and in 28 patients with ulcerative colitis. The control group included 103 Crohn’s disease and 173 ulcerative colitis patients who did not fracture.
In Crohn’s disease, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in seven (54%) compared with 21 (22%) who did not fracture.
In ulcerative colitis, for the group who fractured compared with the controls who did not fracture, corticosteroid use before fracture was evident in five (18%) compared with 37 (21%) who did not fracture.
People with fractures were more likely to be exposed to oral corticosteroids, but this result is not significant, according to the researchers.
Conclusion
People who require corticosteroids in Crohn’s disease should be considered at risk for fracture, stated the researchers. Further research is required to determine after how much corticosteroid use are subjects at risk and/or after what duration of active disease.
Source
Bernstein CN, Blanchard JF, Metge C, Yogendran M. The association between corticosteroid use and development of fractures among IBD patients in a population-based database. The American Journal of Gastroenterology, v98, Issue 8, 1797-1801.