Complications and Extraintestinal Manifestations

You might not realize it but your bones are constantly forming and reforming. They go through a cycle where bone cells form and then get broken down by the body (resorption), and then they reform. Osteoporosis is when there is an imbalance in the formation and resorption of bone. Osteoporosis causes your bones to become brittle. 

Another condition you might hear about is osteopenia, which is a type of pre-osteoporosis.

People with IBD are at higher risk of developing osteopenia and osteoporosis. There are a few reasons for this:

Medications

Systemic corticosteroids are a common treatment for inflammation diseases like IBD. However, they tend to impair the formation of and encourage the death of bone cells. They also reduce the absorption of calcium in the intestines, a vitamin needed for healthy bones. People taking systemic corticosteroids are at higher risk of fractures. After stopping systemic corticosteroids, their risk for fracture goes back to normal.

Inflammation

The inflammation of IBD contributes to the development of osteopenia and osteoporosis. This can occur even without the use of systemic corticosteroids. In inflammation, certain chemicals called cytokines are released, which tend to reduce bone formation and increase bone resorption.

Nutritional deficiencies

Calcium, vitamin D, and vitamin K deficiencies are common with IBD. All of these nutrients are important for bone formation and the maintenance of healthy bones. Visit our section, Nutritional Therapies, for more information. 

If you have IBD and at least one of the following risk factors, you should be screened for osteoporosis using a test for bone mineral density:

• History of vertebral fracture

• Female post-menopause

• Male over the age of 50

• Chronic corticosteroid therapy

• Hypogonadism: reduced function of the testes or ovaries, leading to reduced sex hormone production

If the results are normal, testing should be repeated in two to three years. If, on the other hand, the results show osteoporosis, you should be referred to an osteoporosis specialist. If your results show you have osteopenia, which is ‘pre-osteoporosis,’ you should take preventive steps against osteoporosis and continue to be monitored. 

Here are some ways to help prevent osteoporosis. If you already have osteoporosis, these measures, along with medication, can help to manage it.

• Avoid systemic corticosteroids

• Do weight-bearing exercise

• Do not smoke

• Avoid excessive alcohol

• Take calcium: three glasses a day of milk, or from dark green leafy vegetables, salmon/sardines, or supplements

• Take vitamin D: from fatty fish, egg yolk, fortified foods, or supplements

• See your IBD team for information on what foods to eat and how much

Medication options for osteoporosis include the following:

• Bisphosphonates

• Calcitonin

• Hormone therapy such as estrogen in postmenopausal women

• Parathyroid hormone

• Switching to locally acting corticosteroids such as budesonide for treatment of IBD