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Osteoporosis in IBD-WE CARE In Inflammatory Bowel Disease

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Osteoporosis in IBD-WE CARE In Inflammatory Bowel Disease PowerPoint Presentation

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Slide 1 - Osteoporosis in IBD
Slide 2 - General Risk Factors for Osteoporosis Advancing age Female gender Family history Alcohol use White/Asian race Smoking Physical inactivity Low calcium intake Small and thin body habitus Valentine JF, Sninsky CA. Am J Gastroenterol. 1999;94:878-883. Christchilles EA, et al. Arch Intern Med. 1991;151:2026-2032.
Slide 3 - Risk of Osteoporosis in IBD Low bone mass in 31% to 59% of IBD patients1-3 IBD-related risk factors4 Onset of IBD before reaching age of peak bone mass Inflammatory cytokines Calcium malabsorption Vitamin D deficiency (CD patients) Drugs (corticosteroids, methotrexate, cyclosporine) 1Compston JE. Aliment Pharmacol Ther. 1995;9:237-250. 2Roux C, et al. Osteoporos Int. 1995;5:185-190. 3Andreassen H, et al. Scand J Gastroenterol. 1997;32:1247-1255. 4Valentine JF, Sninsky CA. Am J Gastroenterol. 1999;94:878-883.
Slide 4 - Prevention and Treatment of Osteoporosis in IBD Prevention Baseline and follow-up measurements of bone density (DEXA) Lifestyle and nutritional measures (eg, weight-bearing exercise, smoking cessation, calcium supplementation) Possible HRT for high-risk postmenopausal women Treatment Calcitonin – PTH Bisphosphonates – IV therapies Valentine JF, Sninsky CA. Am J Gastroenterol. 1999;94:878-883.
Slide 5 - Corticosteroid-Induced Bone Loss Bone loss occurs early (weeks to months after initiation of therapy) Cumulative dose, dosage, and duration of corticosteroids may play a role Calcium and small doses of vitamin D may confer limited prophylactic benefit Valentine JF, Sninsky CA. Am J Gastroenterol. 1999;94:878-883.  Van Staa TP, et al. J Bone Mineral Res. 2000;15:993-1000.
Slide 6 - Corticosteroid-Induced Loss of Bone Mass Enhanced bone resorption Reduced intestinal calcium absorption and calcitonin synthesis Increased renal calcium excretion, osteoclastic activity, and parathyroid hormone secretion Enhanced binding of macrophages to bone Reduced bone formation Reduced synthesis of osteoblasts and proliferation of osteoblasts Impaired gonadal hormone production Prednisone associated with increased rate of bone loss Conflicting data regarding budesonide
Slide 7 - Reducing the Risk of Osteoporosis History and physical lab (25-hydroxy vitamin D, albumin, calcium, PTH) Bone density (DEXA) Minimize corticosteroids
Slide 8 - -4 Months Placebo Ris 5.0 mg *P<.05 vs baseline †P<.05 vs control Prevention Study Treatment Study 12 month diff. = 3.8% 12 month diff. = 2.7% % Change from Baseline Lumbar Spine BMD -3 -2 -1 0 1 2 0 3 6 9 12 † * * * † † Bisphosphonates in the Prevention and Treatment of Osteoporosis Cohen S, Levy RM, Keller M, Boling E, et al. Risedronate therapy prevents corticosteroid-induced bone loss: a twelve-month, multicenter, randomized, double-blind, placebo-controlled, parallel-group study. Arthritis Rheum. 1999;42:2309-2318. Copyright© American College of Rheumatology. Reproduced with permission of John Wiley & Sons, Inc. Reproduced from J Bone Miner Res. 2000:15;1006-1013 with permission of the American Society for Bone and Mineral Research. 0 Months 1 2 3 4 0 6 12 * † * * † * *
Slide 9 - Infliximab in Patients With CD and Osteoporosis Prospective, 4-week trial with patients taking corticosteroids Significant decrease in CDAI with infliximab (P=.0001) Increase in surrogate markers for bone turnover Conclusion: increased bone synthesis with no increase in bone resorption CDAI = Crohn’s disease activity index. Abreu MT, et al. Am J Gastroenterol. 2002;97:S269. Abstract 819.
Slide 10 - Summary: Osteoporosis and IBD Bone density is unusually low in patients with active IBD who are taking steroids IBD causes other risk factors, eg, poor calcium absorption and disease-related inflammatory processes, that increase risk of bone loss Monitoring BMD is important Selection of treatment should be considered