Bone Health: An often overlooked aspect of IBD care
M Syafiq Ismail, Olufemi Aoko, Sadaf Amir, Ryan Crawford, Aisling Ganahan, Yii Chun Khiew, Anna Peter, Maria Syed, Emma Anderson, Subhasish Sengupta, John Keohane preprocess
Department of Gastroenterology, Our Lady of Lourdes Hospital (OLOLH), Drogheda
Inflammatory bowel disease (IBD) is a well-known risk factor for metabolic bone disease (MBD). The aetiology is multifactorial. Current guidelines from British Society of Gastroenterology (BSG - 2007 guidelines- Osteoporosis in IBD) recommend routine measurement of bone mineral density (BMD) by dual-energy x-ray Absorptiometry (DEXA) in high risk patients and those who receive prolonged corticosteroid therapy. Treatment of MBD includes lifestyle modifications, as well as pharmacologic therapy (testosterone replacement, bisphosphonates, calcitonin and/or calcium and vitamin D supplementation).
This study aims to review the prevalence of MBD and compliance with BSG guidelines of osteoporosis in IBD patients. We included all the patients seen in gastroenterology OPD in OLOLH, Drogheda in the year 2014.
Data was collected from our IBD database. All patients seen in 2014 were included. We reviewed our radiology system (NIMIS) to see whether patients had DEXA scans. Data for Vitamin D and testosterone levels (males above 55yrs) was obtained from the WinPath electronic record.
A total of 366 patients with IBD were seen in our OPD in 2014. Mean age was 48.2 (18-86). 185 (50.5%) was male and 181(49.5%) was female. 180 (49.2%) patients had Dexa, 161 (43.9%) did not, and 19 (5.2%) patients were uncontactable. Dexa demonstrated 96 (53.3%) patients had normal BMD, 17 (8.9%) osteoporosis and 67 (37.2%) osteopenia. Only 6(1.6%) patients had vitamin D levels checked and none had testosterone level checked. 161 (43.9%) patients had at least one prolonged course of corticosteroids. Among patients who had osteoporosis 16(94%) received treatment with biphosphonates but only 4 (23.5%) had follow up Dexa organised. Among patients who had osteopenia 60 (89.5%) received treatment in the form of calcium and vitamin D supplementation, none had follow up Dexa organised.
Metabolic bone disease is common in IBD patients and there are clear guidelines regarding management of it. In our study we have seen that compliance with the guidelines were poor. Guidelines have now been placed in all outpatient rooms to improve compliance and this will be re-audited.