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Assessment and management of low bone density in inflammatory bowel disease and performance of professional society guidelines1

Etzel, Jason P. MD1; Larson, Meaghan F. MPH2; Anawalt, Bradley D. MD3; Collins, Judith MD1; Dominitz, Jason A. MD, MHS4,5

doi: 10.1002/ibd.21601
Original Article

Background: Inflammatory bowel disease (IBD) patients have increased prevalence of osteoporosis, leading to guideline recommendations for bone mineral density (BMD) testing. The study aim was to identify predictors of BMD testing and treatment and assess guideline effectiveness to identify IBD patients with osteoporosis.

Methods: Records of all IBD patients at seven medical facilities were reviewed for clinical data and BMD testing from January 1996 through October 2006.

Results: A total of 2035 patients had 317 bone density tests performed. Osteopenia was found in 48% of patients, osteoporosis in 26%. Among patients meeting guideline criteria for BMD testing and ≥1 year of follow-up, 23.3% underwent testing. The strongest predictors of testing were menopause (adjusted hazard ratio [AHR] 3.02) and receiving care at a tertiary center (AHR 2.56). Testing rates were low in patients with age ≥60 years, ulcerative colitis, and a history of inpatient IBD treatment. Osteoporotic patients received calcium/vitamin D and bisphosphonates in 59% and 75% of cases, respectively. Osteoporotic males had a 37% rate of hypogonadism. Guideline criteria do not distinguish patients with osteoporosis. The criteria had a sensitivity, specificity, positive predictive value, and negative predictive value of 84%, 23%, 27%, and 81% for osteoporosis in the tested population, respectively.

Conclusions: Osteoporosis is highly prevalent in the IBD population, but BMD testing and osteoporosis treatments are underutilized. Male hypogonadism is common in osteoporotic IBD patients. Guidelines do not identify IBD patients with osteoporosis. Inflamm Bowel Dis 2011

1Division of Gastroenterology, Department of Medicine, Oregon Health and Science University, Portland, Oregon, 2VA Puget Sound Health Care System, Seattle, Washington, 3Division of General Internal Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, 4Northwest Center for Outcomes Research in Older Adults, Seattle Epidemiologic Research and Information Center, VA Puget Sound Health Care System, Seattle, Washington and 5Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington

VAPSHCS (S-111-GI), 1660 S. Columbian Way, Seattle, WA 98108


Received 31 October 2010; Accepted 5 November 2010

Published online 13 January 2011 in Wiley Online Library (

There was no funding for this study. This material is the result of work supported by resources from the VA Puget Sound Health Care System, Seattle, Washington. The views and opinions of the authors expressed herein do not necessarily state or reflect those of the United States Government or the Department of Veterans Affairs. The authors have no conflicts of interest to disclose.

© Crohn's & Colitis Foundation of America, Inc.
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