Original article
Vertebral Fractures and Role of Low Bone Mineral Density in Crohn’s Disease

https://doi.org/10.1016/j.cgh.2007.02.024Get rights and content

Background & Aims: Vertebral fractures in Crohn’s (CD) patients with low bone mineral density (BMD) have been documented as between 14%–22%. Vertebral fractures in CD patients with normal BMD have not been reported. The objectives were to identify the prevalence of vertebral fractures in CD patients and associated predictive factors. Methods: Two hundred twenty-four CD patients underwent vertebral BMD analysis and radiographs. Fractures were identified by using quantitative height reduction morphometry, and severity was assessed by spinal fracture index. Results: Mean age was 40.6 ± 11.0 years. Sixty percent reported corticosteroid use during the preceding year. Forty-five of 224 (20.0%) patients had 88 vertebral fractures. Sixteen of 45 patients with vertebral fractures had normal BMD (19.0% of all patients with normal BMD). Analysis of patients with or without vertebral fractures did not demonstrate significant differences in BMD or in corticosteroid use. Linear regression analysis demonstrated that elevations in body mass index, C-reactive protein, and parathyroid hormone were significantly predictive of vertebral fractures (r = 0.415, P < .05), and height reduction was >20% (r = 0.417, P < .05). Conclusions: This study demonstrates that vertebral fractures in CD patients occur with an equal frequency in those with low and with normal BMD, regardless of corticosteroid use. The mean age of CD patients with vertebral fractures was much lower than that reported in the general population for these fractures. Elevations in body mass index and C-reactive protein and parathyroid hormone levels were predictive of vertebral fractures.

Section snippets

Study Participants

Two hundred twenty-four consecutively encountered patients who had either active or quiescent CD and who were attending the Inflammatory Bowel Disease Referral Clinic at the University of Alberta Hospital (Edmonton, Alberta, Canada) were identified as possible experiment participants between September 2000–July 2001. They completed a questionnaire documenting age, CD diagnosis date, gender, smoking status, and number of flare-ups requiring a visit to the physician and/or corticosteroid use

Patient Characteristics

Descriptive statistics for 224 patients enrolled in this study are outlined in Table 1. Fifty-six percent of the study population was female, and 23% was postmenopausal. The average age of the study population was 38.7 ± 11.8 years. Approximately fifty percent of the group reported corticosteroid use during the year preceding enrollment in the current study. The median lumbar spine T score was −0.71 (25th percentile, −1.47; 75th percentile, −0.07). Median T scores (25th and 75th percentiles)

Discussion

For this study, radiologic assessment of vertebral fractures was performed in a blinded fashion by investigators experienced in such assessments. Each of the 2 methods of assessment (quantitative morphometry and semiquantitative SFI) was performed independently by different investigators. The SFI was chosen as the primary method of vertebral fracture determination. This assessment technique, based on the Genant semiquantitative method, is both highly sensitive and specific in the hands of

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    Supported by Crohn’s and Colitis Foundation of Canada the Cecile Mactaggart Summer Studentship Program and an Unrestricted Research Grant from Proctor and Gamble Pharmaceuticals, Canada.

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