Osteoporosis Updates on IBD and Height Loss
Inflammatory bowel disease and fracture risk. Inflammatory bowel disease (IBD) consists of Crohn's disease (CD) and ulcerative colitis (UC). People with these conditions are at risk for osteoporosis. A recent study done in The Netherlands involved 231,778 fracture cases wherein it was determined the numbers of individuals who also had IBD in an effort to determine the fracture risk of these individuals compared to age-matched controls. See: Gastroenterology. 2003 Dec;125(6):1591-7, van staa TP and others, PMID: 14724810. The authors concluded: "Patients with IBD have a higher risk of fracture due to both disease activity and use of oral corticosteroids. However, few of these patients are receiving optimal bone-sparing therapy, highlighting the importance of increasing awareness of osteoporosis in those managing these patients." In fact, only 13% of these IBD patients who had sustained a fracture were on any form of antifracture treatment. Thus, a recurring situation for readers viewing the Men's Osteoporosis Support Group Website: It pays to know about your disease and to get involved in your care. Your physician may be too busy, or otherwise, to realize that you need preventive/treatment medications for osteoporosis. This appears to be the case in the vast majority of IBD patients. In short, the medications that are approved to treat osteoporosis are: 1) The bisphosphonates such as Fosamax (alendronate), Actonel (risedronate), and others. 2) Forteo, human parathyroid or teraparatide. 3) Miacalcin or Calcimar, injectable or nasally administered calcitonin. 4) Estrogen for women. Calcium and vitamin D should be given along with these medications but are not approved as a treatment if used alone.
Height loss and osteoporosis of the hip. Most of the diagnostic tools for osteoporosis involve either dual-energy X-ray absorptiometry (DXA) or calcaneal ultrasound scans. These require special equipment and a fair amount of time to get an accurate reading. They are important tools that should be used especially when someone is known to be at risk for osteoporosis. One of the ways to know you are at risk is if you detect height loss, which is a simple test that can be done at home, or which your care provider can do during routine appointments. The importance of height loss was highlighted in a recent study in J Clin Densitom. 2004 Spring;7(1):65-70 by Kantor SM and others, PMID: 14742889. This was a cross-sectional study of data from 2108 women who had DXA. It compared self-reported maximum adult height, current height, and total hip bone mineral density. The authors found that height loss of 2 inches or more is a highly significant predictor of osteoporosis at the hip, with increased chance as they lost more height. If they lost 3 inches, this resulted in 9.6 times greater chance of hip osteoporosis. So, it is important to routinely evaluate your height and to become concerned if you begin to lose height--it could well signal osteoporosis. Be sure if you do this at home to try to measure yourself at the same time of the day since there could be slight changes at different times. Best time is probably just after you get up in the morning.