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Review
. 2020 Apr;31(4):637-646.
doi: 10.1007/s00198-019-05234-w. Epub 2019 Dec 10.

Perspective on skeletal health in inflammatory bowel disease

A A van Bodegraven  1   2 , N Bravenboer  3   4
Affiliations
Review

Perspective on skeletal health in inflammatory bowel disease

A A van Bodegraven et al. Osteoporos Int. 2020 Apr.

Abstract

Osteopenia and osteoporosis are common features in inflammatory bowel disease (IBD), comprising both Crohn's disease and ulcerative colitis. Moreover, Crohn's disease is associated with increased fracture risk. The etiology of bone loss in IBD is multifactorial. It includes insufficient intake or absorption of calcium, vitamin D, and potassium; smoking; a low peak bone mass; a low body mass index; and decreased physical activity. In several studies, it has been shown that elevated concentrations of systemic and local pro-inflammatory cytokines, including tumor necrosis factor alpha (TNF-α), interferon-γ (IFNγ), interleukin (IL)-1β, IL-4, IL-5, IL-6, IL-13, and IL-17, present in IBD patients are potentially detrimental for bone metabolism and may be responsible for bone loss and increased fracture risk. This perspective aims to review the current literature on the role of inflammatory factors in the pathophysiology of skeletal problems in IBD and to suggest potential treatment to improve bone health, based on a combination of evidence and clinical and pathophysiological reasoning.

Keywords: Bone loss; Crohn’s disease; Inflammatory bowel disease; Osteoporosis; Ulcerative colitus.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Schematic representation of inflammatory changes and pathophysiology of IBD-associated osteoporosis. Treatment options and likely interference with pro-inflammatory changes underlying decreased bone health in IBD patients
Fig. 2
Fig. 2
Suggested algorithm for diagnosis and treatment of IBD-associated decreased bone health
See this image and copyright information in PMC

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