"Patients with Crohn's often suffer loss of bone mass and an increased number of bone fractures due to treatment with corticosteroids, poor nutrition, active inflammation and calcium and vitamin D deficiencies," said Charles Bernstein, MD, author of an editorial appearing in this month's journal. "Calcium and vitamin D have long been used to enhance bone mass in people with Crohn's, and findings of these studies show it to be sufficient in maintaining BMD in these patients."
Crohn's disease is an inflammatory bowel disease that causes chronic inflammation of the intestinal wall. While the cause of Crohn's is relatively unknown, it usually starts during the teenage years or early adulthood and is characterized by pain in the abdomen, diarrhea and weight loss. According to the most recent data from the National Health Interview Survey, there are more than two million prevalent cases of Crohn's disease in the United States.
According to results of the study from researchers at the University of Alberta, adding the bone-building drug etidronate (Ditronel) to calcium and vitamin D therapy to treat bone loss in people with Crohn's disease adds no additional benefit. This study aimed to assess the efficacy of etidronate on bone loss in patients with Crohn's disease, an effect that has never before been studied in patients who were not menopausal or on corticosteroid therapy.
"Calcium and vitamin D therapy alone provide benefit to Crohn's patients who suffer from osteoporosis and osteopenia," said Richard Fedorak, MD, study author. "We encourage physicians to look for loss of bone density in high risk patients with Crohn's disease and to start calcium and vitamin D therapy immediately if there is either osteoporosis or osteopenia."
Prevention and treatment of low BMD associated with Crohn's disease includes vitamin D and calcium supplementation, education and lifestyle changes such as regular exercise and smoking cessation. Further randomized clinical trials are underway to determine if newer bone-building drugs will have additional beneficial effects on building bone mass in Crohn's patients. The results of those studies will not be available until next year. Until then, researchers suggest vitamin D and calcium supplementation as the primary treatment for bone loss in these patients.
"These results imply that physicians should only consider BMD testing and drug therapy for patients who are at higher risk for osteoporosis and fractures, not those who merely have Crohn's disease as a diagnosis," said Bernstein.
About the Study
Researchers from the University of Alberta in Canada conducted a randomized clinical trial of 150 patients who had Crohn's disease and who attended either the Inflammatory Bowel Disease Referral Clinic (Alberta) or Mt. Sinai Hospital (Toronto). Study participants were classified into three groups following initial measure of BMD: normal bone density, osteopenia and osteoporosis. Patients with osteopenia and osteoporosis were then randomized to calcium and vitamin D supplementation or to etidronate plus calcium and vitamin D supplementation groups.
About the AGA
The American Gastroenterological Association (AGA) is dedicated to the mission of advancing the science and practice of gastroenterology. Founded in 1897, the AGA is the oldest medical-specialty society in the United States. The AGA's 14,000 members include physicians and scientists who research, diagnose and treat disorders of the gastrointestinal tract and liver. On a monthly basis, the AGA publishes two highly respected journals, Gastroenterology and Clinical Gastroenterology and Hepatology. The AGA's annual meeting is Digestive Disease Week, which is held each May and is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and Hepatology is to provide readers with a broad spectrum of themes in clinical gastroenterology and hepatology. This monthly peer-reviewed journal includes original articles as well as scholarly reviews, with the goal that all articles published will be immediately relevant to the practice of gastroenterology and hepatology. For more information, visit www.cghjournal.org.
Journal
Clinical Gastroenterology and Hepatology