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. 2007 Oct;21(10):637-42.
doi: 10.1155/2007/216162.

Improvement of lumbar bone mass after infliximab therapy in Crohn's disease patients

Marina Mauro  1 , Vladimir Radovic, David Armstrong
Affiliations

Improvement of lumbar bone mass after infliximab therapy in Crohn's disease patients

Marina Mauro et al. Can J Gastroenterol. 2007 Oct.

Abstract
in English, French

Background: Patients with Crohn's disease (CD) have a high risk of developing osteoporosis, but the mechanisms underlying bone mass loss are unclear. Elevated proinflammatory cytokines, such as tumour necrosis factor-alpha (TNFalpha), have been implicated in the pathogenesis of bone resorption.

Aim: To assess whether suppression of TNFalpha with infliximab treatment has a beneficial effect on lumbar bone mass.

Methods: Adult CD patients who had received infliximab treatment, and who underwent lumbar densitometric evaluation before and during treatment, were selected. Adult CD patients who had never received infliximab treatment were selected as controls. Information regarding age, sex, weight, duration of CD, use of glucocorticoids and bisphosphonates, and signs of disease activity between both densitometric measurements were collected.

Results: Data from 45 patients were analyzed. The control group (n=30, mean [+/- SD] 26.7+/-9 years of age) had a significantly higher increase in body weight between both evaluations (6.26%+/-8%) than the infliximab group (n=15, 30.6+/-13 years), which had an increase of 0.3%+/-7.4%. There was a strong correlation between the final weight and lumbar bone mineral content (BMC) in both groups. The infliximab group had a significant increase in lumbar bone area (4.15%+/-6.6%), BMC (12.8%+/-13.6%) and bone mineral density (8.13%+/-7.7%) between both evaluations (interval 22.6+/-11 months) compared with the control group. The increase in BMC in patients who had received infliximab treatment was significant when compared with control patients who had received glucocorticoids (n=8) or had evidence of disease activity (n=13).

Conclusion: Infliximab therapy improved lumbar bone mass independent of nutritional status. This finding suggests that TNFalpha plays a role in bone loss in CD.

HISTORIQUE :: Les personnes atteintes de la maladie de Crohn (MC) sont très vulnérables à l’ostéoporose, mais les mécanismes de perte de la masse osseuse sous-jacente ne sont pas clairs. Des cytokines proinflammatoires élevées, tels que le facteur de nécrose tumorale alpha (FNTα), participent à la pathogenèse de la résorption osseuse.

OBJECTIF :: Évaluer si la suppression du FNTα par traitement à l’infliximab a un effet bénéfique sur la masse osseuse lombaire.

MÉTHODOLOGIE :: Les auteurs ont sélectionné des adultes atteints de la MC qui avaient reçu un traitement à l’infliximab et subi une évaluation lombaire par densitométrie avant et pendant leur traitement. Comme sujets témoins, ils ont sélectionné des adultes atteints de la MC qui n’avaient jamais été traités à l’infliximab. Ils ont colligé de l’information au sujet de l’âge, du sexe, du poids, de la durée de la MC, de l’utilisation de glucocorticoïdes et de bisphosphonates et de signes d’activité de la maladie entre les deux mesures de densitométrie.

RÉSULTATS :: Les auteurs ont analysé les données de 45 patients. Le groupe témoin (n=30, moyenne d’âge [±ÉT] de 26,7±9 ans) avait beau-coup pris de poids entre les deux évaluations (6,26 %±8 %) par rapport au groupe prenant de l’infliximab (n=15, 30,6±13 ans), dont la prise de poids était de 0,3 %±7,4 %. On remarquait une forte corrélation entre le poids final et le contenu minéral osseux (CMO) lombaire dans les deux groupes. Le groupe sous infliximab présentait une augmentation importante de la zone osseuse lombaire (4,15 %±6,6 %), du CMO (12,8 %±13,6 %) et de la densité minérale osseuse (8,13 %±7,7 %) entre les deux évaluations (intervalle de 22,6±11 mois) par rapport au groupe témoin. L’augmentation du CMO chez les patients traités à l’infliximab était importante par rapport aux sujets témoins, qui avaient pris des glucocorticoïdes (n=8) ou présentaient des signes probants d’indications de la maladie (n=13).

CONCLUSION :: La thérapie à l’infliximab a amélioré la masse osseuse lombaire, indépendamment du statut nutritionnel. Cette observation laisse supposer que le FNTα joue un rôle dans la perte osseuse en cas de MC.

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Figures

Figure 1)
Figure 1)
Percentage change in L1 to L4 bone mineral content (BMC) between baseline and second densitometric evaluations in the infliximab group (total, and subgroups with and without glucocorticoids) and control group (total, subgroups with and without glucocorticoids, and subgroup with history of flares)
Figure 2)
Figure 2)
Changes in bone mineral content between both densitometric evaluations in the infliximab and control groups for each patient (grey lines with circles) and group means (black lines with squares). For the infliximab group, Time 0.00 indicates the time when infliximab therapy began
See this image and copyright information in PMC

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