Metabolic musculoskeletal disorders in patients with inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is a chronic inflammatory disorder that affects not only the gastrointestinal tract but also extraintestinal organs, leading to various extraintestinal manifestations and complications. Among these, musculoskeletal disorders such as osteoporosis, sarcopenia, and axial and peripheral spondyloarthritis are the most commonly observed. These conditions arise from complex mechanisms, including chronic inflammation, malnutrition, gut dysbiosis, and glucocorticoid use, all of which contribute to reduced bone density, muscle loss, and joint inflammation. Osteoporosis and sarcopenia may co-occur as osteosarcopenia, a condition that heightens the risk of fractures, impairs physical performance, and diminishes quality of life, particularly in elderly patients with IBD. Holistic management strategies, including lifestyle modifications, calcium, and vitamin D supplementation, resistance training, and pharmacological interventions, are essential for mitigating the impact of these conditions. Spondyloarthritis, which affects both axial and peripheral joints, further complicates disease management and significantly compromises joint health. Timely diagnosis and appropriate medical interventions, such as administration of nonsteroidal anti-inflammatory drugs and biologics, are critical for preventing chronic joint damage and disability. Moreover, a multidisciplinary approach that addresses both metabolic and inflammatory aspects is essential for optimizing physical function and improving treatment outcomes in patients who have IBD with musculoskeletal involvement.

Keywords: Inflammatory bowel disease; Osteoporosis; Sarcopenia, Spondyloarthritis.

Figure 1

Overview of the pathophysiologies, diagnostic methods, and treatment strategies for metabolic musculoskeletal complications, including osteoporosis and sarcopenia. DXA, dual-energy X-ray absorptiometry; BIA, bioelectrical impedance analysis.

Figure 2

Classification criteria for axial spondyloarthritis, modified from Rudwaleit et al. [75]. MRI, magnetic resonance imaging; SpA, spondyloarthritis; NSAID, non-steroidal anti-inflammatory drug; CRP, C-reactive protein.

Figure 3

Classification criteria for peripheral spondyloarthritis, modified from Rudwaleit et al. [76]. SpA, spondyloarthritis; IBD, inflammatory bowel disease.